Life & Style | Health
Herbal remedies, not so healthy
Increasingly popular natural therapies are thought of as healthy alternatives, but many of these herbal promises are empty - and potentially lethal.
- By Sangeetha Swaroop, Freelance writer
- Published: 00:19 May 23, 2008
- While it is true that many of the modern medicines in use today are plant-derived, what consumers fail to realise is that unlike evidence-based medicine, there is no standardisation in the herbal supplements industry.
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It took 155 deaths, numerous instances of permanent disability, and dozens of heart attacks and strokes before the US government finally clamped down on the use of ephedra in weight loss supplements in late 2003. Previously, shedding unwanted kilos was as simple as popping ephedra-based tablets without a strict diet and exercise.
Dietary and weight loss supplements don't come cheap, but those who fell for the hoopla lost more than money. Little did they know that ephedra, also known as ma huang, raises blood pressure and stresses the system leading to heart attacks, kidney failure, strokes and, in some cases, death.
Ephedra-free products now flood the market and so do scores of other plant or botanic ingredients-based dietary supplements that are likely to have some form of adverse side effects.
A growing industry
A wide range of vitamins, minerals and herbal remedies form part of a $22 billion a year – and growing steadily – nutraceuticals industry. Unknown to the consumer, they pose an extremely high potential for harm because these non-prescription drugs are rarely tested for safety and/or effectiveness.
Furthermore, being a largely self-regulated industry, the products could contain harmful ingredients like lead and metal. The risk increases substantially since they are easily available to both youngsters and adults as OTC supplements.
Call it ignorance or leniency, but the truth is that while the much-vilified pharmaceutical industry must undertake extensive clinical trials, the "widely accepted" herbal products industry is exempt from such stringent regulations.
Harmless herbs?
Spearheading a personal campaign to raise awareness of the harmful effects of these so-called herbal remedies is Dr Babu Shersad, specialist in Internal Medicine and Nephrologist at First Medical Centre, Dubai. As a kidney specialist, has witnessed the ramifications of mindless dietary pill popping.
Says Dr Shersad, "Herbs have been traditionally used across cultures and countries as natural healing methods long before the advent of modern medicine and as such, many believe these come with a 'no risk' tag."
A 1994 US ruling called the Dietary Supplement Health and Education Act (DSHEA) permitted the proliferation of supplements derived from natural products without first having to submit clinical evidence of their safety and effectiveness to the Food and Drug Administration (FDA).
The law also formally defined the term 'dietary supplement' as a product taken by mouth that contains a 'dietary ingredient' intended to supplement the diet like vitamins, minerals or amino acids.
In the year 2000, herbs were added to the list, further extending the scope of the industry. According to Dr Shersad, "The use of dietary supplements is widespread around the world, and the UAE is no exception.
Their popularity stems from the fact that they can be purchased without prescription. There is an underlying belief that 'natural' products are safer, more effective and don't cause any harm."
Putting it straight
People are looking for a dramatic cure, says Dr Shersad. "The realisation that modern medicine has its limitations is making people gravitate towards alternative therapies.
People past their middle age increasingly turn to supplements to ward off osteoporosis, memory loss and a host of other ailments.
While it is true that many of the modern medicines in use today are plant-derived, what consumers fail to realise is that unlike evidence-based medicine, there is no standardisation in the herbal supplements industry.
"Quality control is minimal and additives can be added during the manufacturing process; ingredients and contents on the labels are often misleading and/or inaccurate and the industry frequently follows no testing procedures to determine efficacy or safety. Some of the few studies which are undertaken using herbal products are poorly designed and anecdotal."
Although the 1994 DSHEA law forbade manufacturers to claim that their products "treat, cure or prevent" any disease – a label reserved exclusively for drugs – the nutraceuticals industry can make structure and function claims.
As Dr Shersad explains, "That is why the label of the popular herbal extract echinacea may say that the herb supports good immune function but will not claim to cure your cold. Manufacturers can also include health claims like diets high in calcium may reduce the risk of osteoporosis, but not state that it will give you this benefit."
According to World Health Organisation (WHO) estimates, up to 80 per cent of indigenous populations in developing countries rely on herbs for primary healthcare needs. Herbs have been used since ancient times
so what makes them harmful now?
Vitamin vitriol
"One main aspect of an OTC remedy is that it is generally not consumed in precise dosages and in some cases excess can be toxic," says Babu.
For instance, excess iron can be especially harmful for men and postmenopausal women who do not need more than the recommended allowance. Many brands supply two or even three times the recommended daily allowance (RDA) of a particular vitamin or ingredient.
There are products in the market that contain active ingredients anywhere from 300 to 1,000 per cent of the RDA. How many consumers would read or even understand the fine print, he asks.
Vitamin supplements can be harmful according to current data, he says. "Even Vitamin C can cause kidney stones in very high doses."
Consumers also tend to confuse structure and function claims with medical benefits, he adds. "The internet is flooded with adverts for herbal products claiming specific health benefits.
But, as I said earlier, consumption of a particular calcium supplement does not necessarily prevent osteoporosis."
Dietary supplements can also cause unpredictable side effects, he says. "For example, studies have shown that prolonged use of ginseng causes water and salt retention leading to high blood pressure and its related complications.
Ginseng is also an anticoagulant while the commonly used echinacea is known to impair kidney function.
"Golden rod, parsley, uva ursi and juniper berries are diuretics; and alfalfa and dandelion create electrolyte problems. The internet is now a tool to illegally market many banned substances."
Unknown ingredients
Yet another reason why herbal remedies can turn harmful is that most contain little or none of the effective extract. "You never know what you are ingesting just by the label," says Babu.
"What consumers also often overlook is that most dietary supplements have the potential for harm, especially when taken in various combinations with one another or with medically prescribed prescription drugs.
For instance, vitamins A, B6, B12, C, E and K, niacin, folic acid, calcium, magnesium, iron and zinc can be hazardous when combined with various prescription drugs and OTC remedies. The potential for danger increases when people with known or hidden health problems take these poorly regulated supplements and fail to report their use to the physicians who treat them.
"Natural products should be subjected to the same scientific testing as conventional medicine," insists Dr Shersad. "There should be a law to restrict the sale of unlicensed herbal products in the country and standardisation should be the norm."
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