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Alternative-Herbal Medicines
By Ron Finley
The medicine cabinet: Where East meets West
In many parts of the world, individuals use both traditional herbal medicines and Western medications concurrently to treat a multitude of medical or psychiatric conditions.
More and more Americans are using the same approach to treat various health conditions. You and your parents or loved ones may believe herbal products are more "natural" and safer than conventional drugs. Or, perhaps your loved one has been diagnosed with a condition for which no conventional Western medication is particularly effective.
What, Exactly, is the Alternative?
More than 20,000 commercial herbal products are available in the U.S. About one third of the adult U.S. population uses medicinal herbs as some form of alternative therapy. The majority of herbs familiar to health professionals and consumers have their roots in Traditional Chinese Medicine (TCM).
In TCM, treatment frequently includes not only herbal remedies, but also acupuncture, meditative exercises – such as qi gong or tai chi – and special diets. When herbals are used in TCM, they are almost always administered as a combination of herbal ingredients, not as a single herb. This practice is based on the belief that the combination is more effective than any of the individual herbs working alone.
Research: It’s your Responsibility
While Western health professionals may be familiar with the popular uses of Ginkgo biloba or ginseng, few have a basic knowledge of TCM. Yet many patients are using TCM, often in addition to Western drugs. Because there are so few checks and balances in place regarding alternative medications, the responsibility falls on the patient or caregiver to decide whether to take an herbal medicine. That’s why it’s so important to become as informed as possible. Simply reading a label won’t be enough.
Labels Tell you Very Little
Alternative herbal products are labeled as dietary or nutritional supplements. The product label should indicate the name of all herbal ingredients, the form and the amount of the herb per dose in milligrams (mg) or grams (gm). A lot number and an expiration date should be included, and a toll free number you can call for additional information.
Unfortunately, some of the information currently available about medicinal plants is either misleading or simply lacking. In some cases, the herbal content of a product is considerably more or less than the strength listed on the label.
Few herbal remedies have been studied to determine drug interactions, best therapeutic use, and potential therapeutic applications. Companies manufacturing alternative herbal products do not have to meet the same quality control standards as companies developing and manufacturing prescription or non-prescription western medications.
“Natural” does not Mean Harmless
Herbal products, as well as western medications, all have the potential for side effects. Because it is “natural” does not mean it is harmless. In addition to the usual hazards of taking a medication, there is the concern that alternative herbal products may contain potentially harmful adulterants. Heavy metals, prescription drugs, and toxic herbs have been found in some herbal products. This is especially true for those manufactured in other countries and imported to the U.S.
Knowledge is the Key to the Best of Both Worlds
So, what precautions can you take to lower the risk of purchasing and using ineffective or unsafe products for your parents or loved ones?
- Buy a product from a well-known manufacturer with a toll free telephone number. Call and ask how the product is tested for purity and potency.
- Avoid buying herbal products manufactured outside the United States.
- Always talk with your doctor and pharmacist about possible drug interactions with medications you are taking.
- Read as much information as you can from reliable sources.
Remember, herbs are essentially crude drugs with the potential for both beneficial and harmful effects. Do your homework; learn all you can about the product. And of course, perhaps the best advice is based on the old adage, “If it sounds too good to be true, it probably isn’t true.”
Selected References/Reading
Dietary supplements: ephedrine alkaloids. FDA. Last accessed October 29, 2000. http://vm.cfsan.fda.gov/~dms/ds-ephed.html
Boullata JI, Nace AM. Safety issues with herbal medicines. Pharmacotherapy 2000; 20:257-69.
FDA, HHS. Dietary Supplements Containing Ephedrine Alkaloids; Withdrawal in Part. Federal Register 2000; 65(64):17474-77. From the Federal Register Online via GPO Access. Last accessed 9/4/00. http://wais.access.gpo.gov.
Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo controlled trial of the ginkgo biloba extract EGb 761 in dementia. Dement Geriatr Cogn Disord 2000; 11(4):230
Oken BS, Storzbach DM, Kaye JA. The efficacy of ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998; 55(11):1409-15
Vale S. Subarachnoid hemorrhage associated with ginkgo biloba. Lancet 1998; 352(9121):36.
Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomised clinical trials. Eur J Clin Pharmacology 1999; 55:567-575.
Foster S, Tyler VE. Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 4th ed. Binghamton, NY: Haworth Herbal Press, 1999.
Ko RJ. Adulterants in Asian patent medicines. N Engl J Med 1998; 339:847.
Gertner E, Marshall PS, Filandrinos D, et al. Complications resulting from the use of Chinese herbal medications containing undeclared prescription drugs. Arth Rheum 1995;38:614-617.
Contaminated herbal products removed from U.S. market. APHA DrugInfoLine April 2000:6.
Brent J. Three new herbal hepatotoxic syndromes. Clin Toxicol 1999; 37(6):715-19.
Vanherweghem J. Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese herbs nephropathy). J Alt Complementary Med 1998;4:9-13.
Lord GM, Tagore R, Cook T, et al. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354:481-82.
Ron Finley
R. Ronald (Ron) Finley, BS Pharm, RPh recently retired, after 28 years as a lecturer for the University of California, San Francisco (UCSF) School of Pharmacy. Ron continues as an Assistant Clinical Professor in the School of Pharmacy and as Clinical Pharmacist in Neurology at the UCSF Memory and Aging Center-Alzheimer’s Research Center, where he works closely with neurologists and psychiatrists. Mr. Finley is also a Consultant Pharmacist for the Institute on Aging at the Alzheimer’s Day Care Center in San Francisco and a consultant to the Parkinson’s Disease Institute. He received his pharmacy degree from St. Louis College of Pharmacy in 1959.
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