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Herbal Supplements

Cooperative Extension

Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department ofAgriculture, James A. Christenson, Director, Cooperative Extension, College of Agriculture and Life Sciences, The University of Arizona.The University of Arizona College of Agriculture and Life Sciencesis an equal opportunity employer authorized to provide research,

educational information, and other services only to individuals and institutions that function without regard to sex, religion, color, nationalorigin, age, Vietnam era Veterans status, or disability.

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THE UNIVERSITYOF ARIZONA

COLLEGEOF AGRICULTUREANDLIFESCIENCES

TUCSON, ARIZONA 85721

Scottie Misner, Ph.D., R.D. Associate Nutrition Specialist

Department of Nutritional Sciences

This information has been reviewed by university faculty.

ag.arizona.edu/pubs/health/az1227.pdf

IntroductionThe num ber and variety of available herbal medi-

cines hav e exploded since the passage of the Dietary

Supp lement H ealth and Education Act of 1994.

Since ancient times, plants have been valued for their

medicinal properties and, many cultures still rely on

plants as their major source of medicine. Many cul-

tur es, includ ing our ow n, have a rich history of plant-

based medicine. Often you may hear the terms

ph ytomed icine, complemen tary med icine, alternative

med icine or herbal med icine used . Extracts from these

medicinal plants as w ell as whole plant forms have

been used to soothe and to heal a wide variety ofailments. Recently herbs have been used to protect

against chron ic disease.

DSHEAHerbal med icines represent a rapidly grow ing seg-

ment of the natur al produ cts market. Congress passed

the Dietary Sup plement H ealth an d Education Act in

1994 (DSHEA, pronou nced D-shay. This act recog-

nized the role that dietary supp lements (wh ich includ e

herbal medicines) can p lay in health prom otion an d

the p revention of chronic disease.This legislation d e-

fined dietary supplements, addressed safety issues

and provided a mechanism for monitoring safety.

DSHEA also called for good man ufacturing practices

to be used in producing dietary supplements. It set

guid elines for regulating health claims and the label-

ing of dietary supplements. This act also established

the Commission on Dietary Supplement Labeling to

develop the supplemen t facts label that is now in place,

and created the Office of Dietary Supp lements.

Safety and PurityIn en acting DSHEA, Congress specifically defined

dietary supp lements as distinct from food and dru gs.

DSHEA required outside comprehensive mon itoringby the Food and Drug Administration (FDA). Both

consumers and health care professionals are con-

cerned abou t whether herbal prod ucts are safe. DSHEA

does not requ ire the extensive premarket app roval of

the FDA that a prescription drug requires. It does

mainta in the FDAs auth ority to protect the p ublic from

unsafe produ cts. However, the burd en of proof that a

dietary supplement is unsafe, is now shifted to the

government. DSHEA also maintains the FDAs right to

establish good man ufacturing p ractices (GMPs), which

are standard for the pharm aceutical industry and felt to

be a key to product pu rity and safety.

German Commission E Much of current Western h erbal med icine is basedup on European phytomedicine. In Europe, herbal med i-

cines are wid ely used an d closely mon itored for safety

and efficacy.

German y, in particular, has been a leader in estab-

lishing regulations regarding herbal medicines. In

1974, scientific commissions were established within

the German Federal Health Agency to review various

categories of dr ugs. Comm ission E is the interdiscipli-

nary commission of scientists and health p rofessionals

charged w ith reviewing herbal med icines. In its review,

the commission considers traditional use; chemical

da ta; clinical, experimental, p harm acological, toxico-

logical and epidemiological studies; patient case

records from physicians files; and unpublished pro-

prietary data from manufacturers to determine the

safety and effectiveness of each herbal med icine. It then

develops mon ographs for informing the pu blic of its

find ings. These monogr aphs have recently been trans-

lated into English and are a useful tool for other

countries attempting to establish high standards for

herbal m edicines.

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2 The University of Arizona Cooperative Extension

Herbal Medicine ExplosionThere has been an explosion in the nu mber of herbal

products available to consumers since the passage of

DSHEA. The following inform ation and practical tips

will help you und erstand w hats available and h elp

you sort through the dizzying array of produ cts.

Herbal medicines are often referred to as herbs or

botanicals. Technically, the term botanical includes

all parts of the plant tha t have m edicinal value, such as

the roots and rhizomes in addition to the leaves, stems

and flowers. Whereas herb refers only to leafy plants

that d ont have w oody stems. The term herbal med i-

cine p erhaps m ore accurately conveys the intended

purpose of the herb, but in reality, you will hear all

three terms u sed interchangeably.

Buying Tips

When buying herbals, how do you know which

brand s and produ cts have the highest quality? How

do you kn ow wh ich prod ucts truly contain what they

claim?Natural does not necessarily mean safe. Herb-

als are essentially dilute drugs and should be used

with the same care and caution as p rescription medica-

tions. Beware that contamination, mislabeling, and

misiden tification still can be a p roblem. Her e are five

tips to help you choose the best herb brand s.

Look for herbal extracts that are standard-

ized. The U.S.P. mark is a clear sign that the

man ufacturer is following U.S. harmacopoeia

standards.

Select products that have been tested . Thelabel will usually say if the brand has un der-

gone scientific testing.

Choose a brand that adheres to higher manu-

facturing standards than are required . All

herbal prod uct man ufacturers have to follow

standards established for food processing

(Food Good Manufacturing Practices or

GMPs).

Buy only single-herb products that clearly

show how much of the herb each dose has.

Some products are mixtures of several herbswith inad equate doses of each.

Beware of claims that sound too good to be

true. Use your common sense. If a claim

pou nd s outrageous to you, trust your instinct.

No one h erbal product can possibly address a

wide spectrum of health concerns.

More scientific research is und erway to help

identify the truly useful herbal produ cts.

Pharm aceutical comp anies have the money to

cond uct resear ch to determine the benefits and r isks of

their herbal prod ucts.

Herb and drug interactions - W hat youshould know.

Although natu ral, and therefore popu larly consid-

ered harmless, herbal supplements contain active in-

gredients that may not safely mix with prescription

or over-the-counter (OTC) drugs. Tell your doctor about

any herbal supplements you take.

In add ition, some m edical problems m ay increase

your risk of adverse effects if you take herbal pr odu cts.

Talk to your doctor before taking any herbal prod ucts if

youre pregnan t or nu rsing or have an y of the follow-

ing med ical cond itions:

H igh blood p ressu re

Blood-clott ing problem

Th yroid problem s

H eart d isease

Par kinsons d isease

Epilepsy

Glaucoma

Enlarged prostate g land

H istory of stroke

Herbals and SurgeryHerbal supplements can be just as dangerous as

prescription and OTC drugs when it comes to their

interaction with an esthesia. Be sure to tell your doctor

about any d rugs including herbal supp lements that

youre taking (and how mu ch youre taking) as soon as

possible if youre anticipating any surgery. According to

the American Society of Anesthesiologists, the following

herbs can affect heart rate and blood pressure:

Ginsing - May cause rapid heartbeat and

increase blood pr essure.

Goldenseal - May cause or worsen highblood pressure.

Ephedra - May elevate blood pressure and

heart rate. Ephed ra commonly is used as an

app etite supp ressant.

Licorice - may increase blood pressure. This

herb isnt to be confused with candy licorice,

wh ich contains little or no actual licorice.

Licorice (Glycyrrhiza glare) commonly is

used to treat stomach pain.

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The University of Arizona Cooperative Extension 3

And , the following herbals may increase you risk of

bleeding.

Garlic

Ginger

Ginkgo

Feverfew

Stop taking herbal supplements at least 2 to 3weeks

before surgery to allow them to clear from your body.

If this isnt possible, bring the herbal product in its

original container to the hosp ital so the anesthesiolo-

gist knows exactly w hat you re taking.

Resources and References

DeBusk, R. Herbal Medicines: A Primer On the Cut-

ting Edge, DCE DPG Newsletter, Winter Edition,

1999, Vol. 20, No. 6.

McGuffin, M., Hobb, C., Upton, R., Goldberg, A., eds.

American Herbal Products Associations Botanical Safety

Handbook: Guidelines for the Safe Use and Labeling for

Herbs of Commerce. Boca Raton, FL, CRC Press; 1997.

Blumenthal, M., Goldberg, A., Gruenw ald, J., Hall, T.,

et al, eds, [Klein, S. and Rister, R. (tran s)]. The Complete

Commission E Monographs: Therapeutic Guide to Herbal

Medicines. (English tran slation). Austin , TX: American

Botanical Coun cil and Boston, MA: Integrative Med i-

cine Communications; 1998.

Additional Useful Resources Books

The PDR Family Guide to Natural Medicines & Healing

Therapies, Medical Econom ics Comp any, 2000.

Tylers Honest Herbal: A Sensible Guide to the Use of Herbs

and Related Remedies, 4th edition, The Haworth Herbal

Press, 1999.

W eb Sites

Office of Dietary Supp lements, Na tional Institutes of

Health, http:/ / dietary-supplements.info.nih.gov/

National Center for Comp lementary and AlternativeMedicine, http:/ / nccam.nih.gov/

Mayo Clinic Health Information,

http:/ / ww.mayoclinic.com/

Any products, services, or organizations that are mentioned, shown, or indirectly implied in this publication do not imply

endorsement by The Un iversity of Arizona.