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Supplementing Confusion
September 26, 2003

By Louis Wittig - eCureMe Staff Writer
Physician Reviewed - September 23,2003

This month the New England Journal of Medicine released a series of studies highlighting the dangers of popular herbal supplements and called on the federal government to regulate them more strictly. The calls, continuing the decade long debate over the safety and efficacy of products such as St.John’s Wort, Gingko and Echinacea, draw attention to the uncertainty and health risks millions of consumers face as they try to integrate the supplements into their diet.

One study published by the journal found that St. John’s Wort, touted as a remedy for depression, increased the body’s processing of certain types of drugs. Thus, when taken in conjunction with St. John’s Wort, some kinds of birth control, cancer drugs and cholesterol medication don’t have the effect they were designed to. A second study surveyed on-line supplement retailers and found that 55% claimed their products could treat, prevent or cure specific conditions; claims there is little or no scientific evidence to support.

Sales of the herbal remedies in the U.S.? which topped $18 billion in 2001 ? are based mostly on anecdotal evidence, and so far the government hasn’t required anything more. In 1994, Congress passed the Dietary Supplement and Health Education Act (DSHEA). The legislation prevented the Food and Drug Administration (FDA) from making herbal manufacturers prove that their products were safe or effective; the standard drug companies have to meet when marketing a new anti-viral drug or cough syrup. Herbal manufacturers are permitted to claim that their products promote health, and are only barred from advertising that they cure any specific condition.

The lack of oversight has major implications for what shows up on pharmacy and health food store shelves. The quality of herbals can vary greatly from batch to batch. Because the plants that the herbals are derived can be grown, harvested and processed in different ways one bottle of Valerian Root might be pure, while another might not; even if they’re the same brand name. When tested, some herbals have been found to contain unlisted chemical ingredients, including heavy metals.

Compounding the issue of purity is the issue of effectiveness. After Congress passed DSHEA, it created the National Center for Complementary and Alternative Medicine (NCCAM) in 1998 to study the role of the profusion of new herbals were having on the nation’s health. Studies funded by the NCCAM, as well others, have come to mixed conclusions about how helpful herbals can be ? even if the product contains what it claims. Some studies have shown that St.John’s Wort is effective in treating cases of mild depression. A 2001 Vanderbilt University study found otherwise, concluding after an eight-week trial that the herb was useless in treating serious depression.

Similarly confusing evidence has been found in studies of Feverfew, an herbal that supposedly alleviates headaches and menstrual irregularities. Sage oil, on the other hand, has been found to significantly increase memory function by British scientists, and is currently being developed as an Alzheimer’s treatment. Trying to make decisions based on this scattered and contradictory data would try most consumers’ wits, and most of what makes it to their diet hasn’t been as rigorously studied.

Until Congress hears the arguments of the New England Journal of Medicine and physicians around the country, consumers exploring herbals will likely face a process of trial-and-error. While the recent study on herbals and drug metabolism does raise the specter of serious health risks, the FDA takes the position that herbals are generally safe until proven otherwise.

Efficacy is another issue, and before committing to any supplement regimen, consumers should research the herbal they’re thinking of taking and discuss their plans with their doctor, especially if they’re on any prescription medication.

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