The Everything Guide to Herbal Remedies (32 page)

Herbs and spices have been used to perk up foods for about as long as people have been eating. Many pack a big nutritional (and medicinal) punch along with their flavorings. They include:

Several herbs have thermogenic properties—they can increase the body’s natural “fat burning” abilities. Here are a few:

Many edible plants have proven weight loss benefits—and can easily be incorporated into your diet. They include:

Over the past several years, as interest in complementary and alternative medicine (CAM) and herbal medicine in particular has grown, concerns over the safety (and general advisability) of using herbal remedies has been a subject of great concern. The issues of safety and efficacy go hand-in-hand: Who’d want to use something that isn’t safe? And why bother about the safety of a remedy that isn’t even effective?

Herbal products are classified as either dietary supplements or cosmetics—not medicines—and therefore are handled differently than drugs by the Food and Drug Administration (FDA).

In 1994, Congress passed the Dietary Supplements Health and Education Act (DSHEA), which expanded the definition of “dietary supplement” to include herbs and other botanicals (anything except tobacco) along with vitamins and minerals. The law requires that food products, cosmetics, and supplements be free of “adulteration” and prohibits them from being “misbranded.” Manufacturers are also required to use safe ingredients: Anything that was available before 1994 is considered safe, and anything that’s been introduced since that time must pass a premarket evaluation by the FDA.

Of course, that’s a far cry from the elaborate approval process that would-be drugs face, a fact that leaves some people questioning the inherent safety of herbal products. But herbs don’t have it any better (or worse) than any other supplement or cosmetic. The government is surprisingly hands-off in its supervision of the popular (and potentially dangerous) products so many of us pop into our mouths or apply to our bodies every day.

Most Americans assume that the products they buy are being closely monitored—and the mere fact that they’re being sold in stores (and not in shady alleyways or on suspicious websites) proves that they’re both safe and effective. But both prescription and over-the-counter (OTC) drugs cause more than a million recorded poisonings—and more than 500 fatalities—every year. And cosmetics can cause problems, too. According to the Environmental Working Group, nearly 90 percent of the ingredients in personal care products have not been assessed for safety, and many products contain ingredients that that are known toxins, such as mercury and lead.

Herbal products, in contrast, are almost never involved in cases of serious toxicity or other ill effects. In fact, the vast majority of poisoning cases involving an herbal product involve accidental ingestion by a young child.

The regulations state that herbal products intended to supplement the diet and taken by mouth (such as pills, capsules, or liquids) are classified as dietary supplements. Products that are used externally for self-care or grooming are considered cosmetics.

The FDA can evaluate products and inspect manufacturing facilities at its discretion, but the agency can step in and try to stop the sale of a product (or take action against the company that’s selling it) only after the product has been shown to be in violation of the law. Imported herbal products must comply with the same regulatory requirements and are subject to search and sampling by the U.S. Customs Service when they arrive in the country.

Not surprisingly, the government requires very different things from drugs than it does from supplements and cosmetics when it comes to labeling.

Prescription medicines must list the drug’s uses, side effects, and other information. OTC drugs are required to provide similar information, including:

• Product name

• Active ingredients (the therapeutic agents)

• Purpose (the product category, such as “antihistamine”)

• Uses (the symptoms or condition being treated)

• Directions (how much to take, when to take it, etc.)

• Other information (such as storage guidelines)

• Inactive ingredients (binders, flavorings—the nontherapeutic things)

• Net quantity of contents

• Name and address of manufacturer or distributor

Herbs and other supplements can have significantly less on their labels. The FDA requires the following:

• Product name (plus the words “dietary supplement”)

• Nutrition information (a “Supplement Facts” box similar to the “Nutrition Facts” box that’s on food packages, which lists the active ingredients, including the part of the plant from which the ingredient is derived)

• Other ingredients (things that are considered inactive or are nonessential nutrients are listed here, below the Supplements Facts)

• Net quantity of contents

• Manufacturer/distributor information (if the product is imported, the label must disclose the country of origin)

This means that you might not be able to tell much from an herbal product’s label. For example, a bottle of hawthorn
(Crataegus monogyna, C. oxyacantha)
capsules might include a picture of the herb (a thorny bush covered with white flowers or red berries) but not the condition or body part it’s good for (an ailing human heart). Many manufacturers include dosages and guidelines, but not all do.

Dietary supplements are prohibited from claiming to diagnose, cure, mitigate, treat, or prevent a disease—a bit of regulatory red tape that can leave consumers in the dark. But supplement manufacturers are allowed to make these claims on product labels and in advertising and marketing materials:

• Health claims
mention the relationship between an herb or another ingredient and a lowered risk of a particular disease or condition. For example, products containing vitamins E or C may include a statement on how antioxidants can lower your risk of developing cancer.

• Nutrient content claims
describe the relative amount of a nutrient or dietary substance in a product. For example, a multivitamin might claim to deliver a full day’s supply of a particular vitamin.

• Structure and function claims
describe how a product may affect the organs or systems of the body but can’t mention any specific disease. For example, a calcium supplement’s label might say “Calcium builds strong bones,” but not “Calcium prevents osteoporosis.” Structure and function claims must be accompanied by the disclaimer: “These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

While some herbs can interfere with certain medications, most can be used without fear of interactions. In comparison, OTC antacids, which are some of the most widely used drugs in the United States, can interact with a long list of other medications, including many those used to treat acne, diabetes, anxiety, thyroid problems, and—ironically—ulcers.

Beyond the regulatory distinctions, herbs and drugs differ in another big way: While drugs contain a specific amount of specific ingredients, plants—even plants of the same species—can vary quite a bit in their contents.

A plant’s chemical makeup can be affected by many things, including the environment it was raised in, the way it was harvested and processed, and how it was stored. So while a pharmaceutical company can, at least in theory, control every detail of the pills it produces, herbal products manufacturers must leave a lot to nature.

It’s been said that herbal medicines and pharmaceuticals arrive at the same destination—the shelf in your neighborhood drug store—from opposite directions. Pharmaceuticals are created in a lab in response to a specific need or to treat a specific condition. Herbs have been around for ages while humans have proceeded, through trial and error, to figure out how to use them.

Preclinical research involves basic science and usually begins with
in vitro
studies, which are conducted on isolated cells (in
vitro
means “within the glass” in Latin).
In vitro
studies gauge a substance’s effects on live tissue.

Next,
in vivo
(or “within the living”) research uses live animals, often mice and rats, to see what the substance does to a living animal.

Human studies, as you might expect, are experiments conducted on people. They can involve
epidemiological
research, which analyzes data on the use of the herb in a particular group and its relationship to disease and mortality rates, or an analysis of several previously published human trials (called a
meta-analysis).

Human research also involves
clinical trials,
which compare the substance to a drug or other agent or to a placebo, which is a substance with no pharmaceutical effect (a “sugar pill”), to determine its effectiveness. The best trials are double-blind, meaning that neither the subjects nor the test administrators know who is getting the herb and who is getting the other agent or placebo. This eliminates the risk of prejudice.

Because they must go through a much more elaborate process in order to be approved for sale, pharmaceuticals are much more rigorously tested than herbs (remember, it’s much easier to get “dietary supplement” than “drug” status). Thus, the research on many herbs stops at the
in vivo
stage.

However, there have been several important human clinical trials on herbs in recent years, many of which have shown herbs to be safe and effective alternatives to synthetic drugs.

Of course, herbs do have one big advantage over drugs: They’ve been used safely and successfully for thousands of years. Dose for dose, they are almost always less potent than their pharmaceutical counterparts, meaning they present far less risk of toxicity than drugs do. Many have no known side effects (or very, very mild ones) for people who are otherwise healthy and not taking other medications. Nonetheless, they are medicines and should be treated with care.