Natural Products and Safety Issues

National Center for Complementary and Integrative Health sent this bulletin at 12/02/2015 12:18 PM EST
“
Natural products such as herbal medicines or botanicals are often sold as dietary supplements and are readily available to consumers; however, there is a lot we don’t know about the safety of many of these products.
Two of the main safety concerns for dietary supplements are:
—The possibilities of drug interactions—for example, research has shown that St. John’s wort interacts with drugs such as antidepressants in ways that can interfere with their intended effects
—The possibilities of product contamination—supplements have been found to contain hidden prescription drugs or other compounds, particularly in dietary supplements marketed for weight loss, sexual health including erectile dysfunction, and athletic performance or body-building.
As with any treatment, it’s important to consider safety before using complementary health products and practices. Read more at https://nccih.nih.gov/health/safety.“
Additionally…
Dietary Supplements Land Thousands in the ER Each Year
https://www.nlm.nih.gov/medlineplus/news/fullstory_155144.html
Side effects from dietary supplements send more than 20,000 Americans to the emergency room each year, a new government study reveals.
[Repost] Sleep Probelms and Complementary Approaches
From the US National Center of Complementary and Integrative Health (NCCIH) – part of NIH
What’s the Bottom Line?
What do we know about the usefulness of complementary approaches for sleep disorders?
- Relaxation techniques can be helpful for insomnia.
- Melatonin supplements may be helpful for sleep problems caused by shift work or jet lag. Melatonin may also be helpful for people with insomnia, but its effect is small.
- The evidence for other complementary approaches is either inconsistent or too limited to draw conclusions about whether they are helpful for sleep disorders.
What do we know about the safety of complementary approaches for sleep disorders?
- Relaxation techniques are generally considered safe.
- Melatonin appears to be relatively safe for short-term use, but its long-term safety has not been established.
- There are serious safety concerns about kava products (which have been linked to severe liver damage) and L-tryptophan supplements (which may be associated with a potentially serious disorder called eosinophilia-myalgia syndrome).
- If you use a complementary approach for a sleep problem, tell your health care providers. They can do a better job caring for you if they know what you’re using.
What Are Sleep Disorders and How Important Are They?
There are more than 80 different sleep disorders. This fact sheet focuses on insomnia—difficulty falling asleep or difficulty staying asleep. Insomnia is one of the most common sleep disorders.
More information
Chronic, long-term sleep disorders affect millions of Americans each year. These disorders and the sleep deprivation they cause can interfere with work, driving, social activities, and overall quality of life, and can have serious health implications. Sleep disorders account for an estimated $16 billion in medical costs each year, plus indirect costs due to missed days of work, decreased productivity, and other factors.
To learn more about sleep disorders, visit the National Heart, Lung, and Blood Institute (NHLBI) Web site.
Is It a Sleep Disorder or Not Enough Sleep?
Some people who feel tired during the day have a true sleep disorder, but for others, the real problem is not allowing enough time for sleep. Adults need at least 7 to 8 hours of sleep each night to be well rested, but the average adult sleeps for less than 7 hours a night.
More information
Sleep is a basic human need, like eating, drinking, and breathing, and is vital to good health and well-being. Shortchanging yourself on sleep slows your thinking and reaction time, makes you irritable, and increases your risk of injury. It may even decrease your resistance to infections, increase your risk of obesity, and increase your risk of heart disease. To learn more about healthy sleep and what happens when you don’t get enough sleep, visit NHLBI’s Your Guide to Healthy Sleep and What Are Sleep Deprivation and Deficiency?.
What the Science Says About Complementary Health Approaches and Insomnia
Research has produced promising results for some complementary health approaches for insomnia, such as relaxation techniques. However, evidence of effectiveness is still limited for most products and practices, and safety concerns have been raised about a few.
Mind and Body Practices
- There is evidence that relaxation techniques can be effective in treating chronic insomnia.
More information
- Progressive relaxation may help people with insomnia and nighttime anxiety.
- Music-assisted relaxation may be moderately beneficial in improving sleep quality in people with sleep problems, but the number of studies has been small.
- Various forms of relaxation are sometimes combined with components of cognitive-behavioral therapy (such as sleep restriction and stimulus control), with good results.
- Using relaxation techniques before bedtime can be part of a strategy to improve sleep habits that also includes other steps, such as maintaining a consistent sleep schedule; avoiding caffeine, alcohol, heavy meals, and strenuous exercise too close to bedtime; and sleeping in a quiet, cool, dark room.
- Relaxation techniques are generally safe. However, rare side effects have been reported in people with serious physical or mental health conditions. If you have a serious underlying health problem, it would be a good idea to consult your health care provider before using relaxation techniques.
- In a preliminary study, mindfulness-based stress reduction, a type of meditation, was as effective as a prescription drug in a small group of people with insomnia.
More information
- Several other studies have also reported that mindfulness-based stress reduction improved sleep, but the people who participated in these studies had other health problems, such as cancer.
- Preliminary studies in postmenopausal women and women with osteoarthritis suggest that yoga may be helpful for insomnia.
- Some practitioners who treat insomnia have reported that hypnotherapy enhanced the effectiveness of cognitive-behavioral therapy and relaxation techniques in their patients, but very little rigorous research has been conducted on the use of hypnotherapy for insomnia.
- A small 2012 study on massage therapy showed promising results for insomnia in postmenopausal women. However, conclusions cannot be reached on the basis of a single study.
- Most of the studies that have evaluated acupuncture for insomnia have been of poor scientific quality. The current evidence is not rigorous enough to show whether acupuncture is helpful for insomnia.
For more information on mind and body practices.
Dietary Supplements
Melatonin and Related Supplements
- Melatonin may help with jet lag and sleep problems related to shift work.
- A 2013 evaluation of the results of 19 studies concluded that melatonin may help people with insomnia fall asleep faster, sleep longer, and sleep better, but the effect of melatonin is small compared to that of other treatments for insomnia.
More information
- Studies of melatonin in children with sleep problems suggest that it may be helpful, both in generally healthy children and in those with conditions such as autism or attention-deficit hyperactivity disorder. However, both the number of studies and the number of children who participated in the studies are small, and all of the studies tested melatonin only for short periods of time.
- Melatonin supplements appear to be relatively safe for short-term use, although the use of melatonin was linked to bad moods in elderly people (most of whom had dementia) in one study.
- The long-term safety of melatonin supplements has not been established.
- Dietary supplements containing substances that can be changed into melatonin in the body—L-tryptophan and 5-hydroxytryptophan (5-HTP)—have been researched as sleep aids.
More information
- Studies of L-tryptophan supplements as an insomnia treatment have had inconsistent results, and the effects of 5-HTP supplements on insomnia have not been established.
- The use of L-tryptophan supplements may be linked to eosinophilia-myalgia syndrome (EMS), a complex, potentially fatal disorder with multiple symptoms including severe muscle pain. It is uncertain whether the risk of EMS associated with L-tryptophan supplements is due to impurities in L-tryptophan preparations or to L-tryptophan itself.
Herbs
- Although chamomile has traditionally been used for insomnia, often in the form of a tea, there is no conclusive evidence from clinical trials showing whether it is helpful. Some people, especially those who are allergic to ragweed or related plants, may have allergic reactions to chamomile.
- Although kava is said to have sedative properties, very little research has been conducted on whether this herb is helpful for insomnia. More importantly, kava supplements have been linked to a risk of severe liver damage.
- Clinical trials of valerian (another herb said to have sedative properties) have had inconsistent results, and its value for insomnia has not been demonstrated. Although few people have reported negative side effects from valerian, it is uncertain whether this herb is safe for long-term use.
- Some “sleep formula” dietary supplements combine valerian with other herbs such as hops, lemon balm, passionflower, and kava or other ingredients such as melatonin and 5-HTP. There is little evidence on these preparations from studies in people.
For more information on dietary supplements.
Other Complementary Health Approaches
- Aromatherapy is the therapeutic use of essential oils from plants. It is uncertain whether aromatherapy is helpful for treating insomnia because little rigorous research has been done on this topic.
- A 2010 systematic review concluded that current evidence does not demonstrate significant effects of homeopathic medicines for insomnia.
NCCIH Research on Sleep Disorders
NCCIH funds research on complementary health approaches for sleep disorders.
More information
Recent projects include studies on:
- How mindfulness meditation training may affect the amount and quality of sleep
- The effect of blue-white light on sleep disorders in patients with Alzheimer’s disease
- Whether acupuncture can help insomnia
- How two forms of mindfulness-based therapy compare with behavior therapy for treating insomnia.
Could You Have Sleep Apnea?
Do you snore loudly? Does your bed partner say that you make gasping or snorting sounds during the night? Do you fight off sleepiness during the day?
If you have any of these symptoms, talk to your health care provider. You might have sleep apnea—a condition in which sleep is disrupted because of pauses in breathing. For more information, visit the NHLBI Web site.
If You’re Considering Complementary Health Approaches for Sleep Problems
- Talk to your health care providers. Tell them about the complementary health approach you are considering and ask any questions you may have. Because trouble sleeping can be an indication of a more serious condition, and because some prescription and over-the-counter drugs can contribute to sleep problems, it is important to discuss your sleep-related symptoms with your health care providers before trying any complementary health product or practice.
- Be cautious about using any sleep product—prescription medications, over-the-counter medications, dietary supplements, or homeopathic remedies. Find out about potential side effects and any risks from long-term use or combining products.
- Keep in mind that “natural” does not always mean safe. For example, kava products can cause serious harm to the liver. Also, a manufacturer’s use of the term “standardized” (or “verified” or “certified”) does not necessarily guarantee product quality or consistency. Natural products can cause health problems if not used correctly. The health care providers you see about your sleep problems can advise you.
- If you are pregnant, nursing a child, or considering giving a child a dietary supplement or other natural health product, it is especially important to consult your (or your child’s) health care provider.
- If you are considering a practitioner-provided complementary health practice, check with your insurer to see if the services will be covered, and ask a trusted source (such as your health care provider or a nearby hospital or medical school) to recommend a practitioner.
- Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
For More Information
NCCIH Clearinghouse
The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
National Heart, Lung, and Blood Institute (NHLBI)
The NHLBI Health Information Center provides information to health professionals, patients, and the public about heart, lung, and blood diseases and sleep disorders and accepts orders for publications.
MedlinePlus
To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
PubMed®
A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.
Key References
- Allen JA, Peterson A, Sufit R, et al. Post-epidemic eosinophilia-myalgia syndrome associated with L-tryptophan. Arthritis and Rheumatism. 2011;63(11):3633–3639.
- Cheuk DKL, Yeung WF, Chung KF, et al. Acupuncture for insomnia. Cochrane Database of Systematic Reviews. 2012;(9):CD005472. Accessed at http://www.thecochranelibrary.com on January 20, 2014.
- Cooper KL, Relton C. Homeopathy for insomnia: a systematic review of research evidence. Sleep Medicine Reviews. 2010;14(5):329–337.
- de Niet G, Tiemens B, Lendemeijer B, et al. Music-assisted relaxation to improve sleep quality: meta-analysis. Journal of Advanced Nursing. 2009;65(7):1356–1364.
- Ernst E, Lee MS, Choi T-Y. Acupuncture for insomnia? An overview of systematic reviews. European Journal of General Practice. 2011;17(2):116–123.
- Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013;8(5):e63773.
- Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults. Clinics in Geriatric Medicine. 2008;24(1):121–138.
- Gross CR, Kreitzer MJ, Reilly-Spong M, et al. Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore. 2011;7(2):76–87.
- Kierlin L. Sleeping without a pill: nonpharmacologic treatments for insomnia. Journal of Psychiatric Practice. 2008;14(6):403–407.
- National Cancer Institute. Aromatherapy and Essential Oils. National Cancer Institute Web site. Accessed at www.cancer.gov/cancertopics/pdq/cam/aromatherapy/healthprofessional/AllPages on January 20, 2014.
- Ng B-Y, Lee T-S. Hypnotherapy for sleep disorders. Annals of the Academy of Medicine, Singapore. 2008;37(8):683–688.
- Oliveira DS, Hachul H, Goto V, et al. Effect of therapeutic massage on insomnia and climacteric symptoms in postmenopausal women. Climacteric. 2012;15(1):21–29.
- Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 National Health Interview Survey Data. Archives of Internal Medicine. 2006;166(16):1775–1782.
- Riemersma-van der Lek RF, Swaab DF, Twisk J, et al. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299(22):2642–2655.
- Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Medicine Reviews. 2011;15(2):99–106.
- Siebern AT, Manber R. Insomnia and its effective non-pharmacologic treatment. Medical Clinics of North America. 2010;94(3):581–591.
- Taibi DM, Landis CA, Petry H, et al. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Medicine Reviews. 2007;11(3):209–230.
- Taibi DM, Vitiello MV. A pilot study of gentle yoga for sleep disturbance in women with osteoarthritis. Sleep Medicine. 2011;12(5):512–517.
All Other References
- Afonso RF, Hachul H, Kozasa EH, et al. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial. Menopause. 2012;19(2):186–193.
- Andersen SR, Würtzen H, Steding-Jessen M, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncologica. 2013;52(2):336–344.
- Balick MJ, Herrera K, Musser SM. Kava. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. New York, NY: Informa Healthcare; 2010:459–468.
- Belongia EA, Hedberg CW, Gleich GJ, et al. An investigation of the cause of the eosinophilia-myalgia syndrome associated with tryptophan use. New England Journal of Medicine. 1990;323(6):357–365.
- Britton WB, Haynes PL, Fridel KW, et al. Mindfulness-based cognitive therapy improves polysomnographic and subjective sleep profiles in antidepressant users with sleep complaints. Psychotherapy and Psychosomatics. 2012;81(5):296–304.
- Brzezinski A, Vangel MG, Wurtman RJ, et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Medicine Reviews. 2005;9(1):41–50.
- Buscemi N, Vandermeer B, Hooton N, et al. The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. Journal of General Internal Medicine. 2005;20(12):1151–1158.
- Cappuccio FP, Taggart FM, Kandala N-B, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31(5):619–626.
- Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine. 2005;12(4):278–285.
- Carter PJ, Taylor BJ, Williams SM, et al. Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study. BMJ. 2011;342:d2712.
- Centers for Disease Control and Prevention. Epidemiologic notes and reports: eosinophilia-myalgia syndrome and L-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989. MMWR. 1989;38(46):785–788.
- Centers for Disease Control and Prevention. Hepatic toxicity possibly associated with kava-containing products—United States, Germany, and Switzerland, 1999–2002. MMWR. 2002;51(47):1065–1067.
- Cummings C, Canadian Paediatric Society, Community Paediatrics Committee. Melatonin for the management of sleep disorders in children and adolescents. Paediatrics and Child Health. 2012;17(6):331–336.
- Fernández-San-Martín MI, Masa-Font R, Palacios-Soler L, et al. Effectiveness of valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Medicine. 2010;11(6):505–511.
- Gross CR, Kreitzer MJ, Thomas W, et al. Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial. Alternative Therapies in Health and Medicine. 2010;16(5):30–38.
- Gyllenhaal C, Merritt SL, Peterson SD, et al. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Medicine Reviews. 2000;4(3):229–251.
- Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database of Systematic Reviews. 2002;(2):CD001520 [edited 2009]. Accessed at http://www.thecochranelibrary.com on January 20, 2014.
- Jacobs GD. Clinical applications of the relaxation response and mind-body interventions. Journal of Alternative and Complementary Medicine. 2001;7 (suppl 1):S93–101.
- Kleinman NL, Brook RA, Doan JF, et al. Health benefit costs and absenteeism due to insomnia from the employer’s perspective: a retrospective, case-control, database study. Journal of Clinical Psychiatry. 2009;70(8):1098–1104.
- Meoli AL, Rosen C, Kristo D, et al. Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence. Journal of Clinical Sleep Medicine. 2005;1(2):173–187.
- Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007;30(11):1445–1459.
- Morin CM, Bootzin RR, Buysse DJ, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep. 2006;29(11):1398–1414.
- Morin AK, Jarvis CI, Lynch AM. Therapeutic options for sleep-maintenance and sleep-onset insomnia. Pharmacotherapy. 2007;27(1):89–110.
- Morone NE, Lynch CS, Greco CM, et al. “I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. Journal of Pain. 2008;9(9):841–848.
- National Institute of Neurological Disorders and Stroke. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke Web site. Accessed at www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm on January 20, 2014.
- National Institutes of Health. NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consensus Science Statements. 2005;22(2):1–30.
- Naudé DF, Couchman IM, Maharaj A. Chronic primary insomnia: efficacy of homeopathic simillimum. Homeopathy. 2010;99(1):63–68.
- Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytotherapy Research. 2011;25(8):1153–1159.
- Office of Dietary Supplements. Valerian. Office of Dietary Supplements Web site. Accessed at ods.od.nih.gov/factsheets/Valerian-HealthProfessional/ on January 20, 2014.
- Ong JC, Shapiro SL, Manber R. Mindfulness meditation and cognitive behavioral therapy for insomnia: a naturalistic 12-month follow-up. Explore. 2009;5(1):30–36.
- Patel SR, Blackwell T, Redline S, et al. The association between sleep duration and obesity in older adults. International Journal of Obesity. 2008;32(12):1825–1834.
- Smith MJ, Garrett RH. A heretofore undisclosed crux of eosinophilia-myalgia syndrome: compromised histamine degradation. Inflammation Research. 2005;54(11):435–450.
- Srivastava JK, Shankar E, Gupta S. Chamomile: a herbal medicine of the past with bright future. Molecular Medicine Reports. 2010;3(6):895–901.
- Taavoni S, Ekbatani N, Kashaniyan M, et al. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. 2011;18(9):951–955.
- Teschke R, Sarris J, Schweitzer I. Kava hepatotoxicity in traditional and modern use: the presumed Pacific kava paradox hypothesis revisited. British Journal of Clinical Pharmacology. 2012;73(2):170–174.
- Vickers A, Zollman C, Payne DK. Hypnosis and relaxation therapies. Western Journal of Medicine. 2001;175(4):269–272.
- Zick SM, Wright BD, Sen A, et al. Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. BMC Complementary and Alternative Medicine. 2011;11:78.
Acknowledgments
NCCIH thanks Ronald Glick, M.D., University of Pittsburgh; Nalaka Gooneratne, M.D., University of Pennsylvania; Michael Twery, Ph.D., National Heart, Lung, and Blood Institute; and D. Lee Alekel, Ph.D., and John (Jack) Killen, Jr., M.D., NCCIH, for their contributions to the 2014 update of this publication.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.
[News item] Should You Take Dietary Supplements? (with links to resources)
Someone I know takes a multitude of supplements. As this article points out, it is a good idea to get objective medical advice on which supplements may be helpful. This person started taking Vitamin D on the advice of a friend to stop back pain. It did work. And to to be honest, I was very skeptical. After a year, he told his doctor, and the doctor said that it probably did help. However, I do think that overall if folks ate right that supplements would be unnecessary.
Also, as the article points out, supplements cannot reverse medical conditions or replace other therapies.
Looking for more information on supplements? Check out the resources below, after the article summary.
A Look at Vitamins, Minerals, Botanicals and More
From the NIH August 2013 Newsletter
When you reach for that bottle of vitamin C or fish oil pills, you might wonder how well they’ll work and if they’re safe. The first thing to ask yourself is whether you need them in the first place.
More than half of all Americans take one or more dietary supplements daily or on occasion. Supplements are available without a prescription and usually come in pill, powder or liquid form. Common supplements include vitamins, minerals and herbal products, also known as botanicals.
People take these supplements to make sure they get enough essential nutrients and to maintain or improve their health. But not everyone needs to take supplements.
“It’s possible to get all of the nutrients you need by eating a variety of healthy foods, so you don’t have to take one,” says Carol Haggans, a registered dietitian and consultant to NIH. “But supplements can be useful for filling in gaps in your diet.”
Some supplements may have side effects, especially if taken before surgery or with other medicines. Supplements can also cause problems if you have certain health conditions. And the effects of many supplements haven’t been tested in children, pregnant women and other groups. So talk with your health care provider if you’re thinking about taking dietary supplements.
Resources
- Dietary Supplement Fact Sheets (US National Institutes of Health)
with links to decision making aids and consumer protection information - Dietary Supplement Label Database (US National Institutes of Health)
ingredients of thousands of dietary supplements with information from the label on dosage, health claims and cautions - Drugs, Supplements, and Herbal Information (US National Library of Medicine)
browse dietary supplements and herbal remedies to learn about their effectiveness, usual dosage, and drug interactions.
- Longwood Herbal Task Force
This site has in-depth monographs about herbal products and supplements written by health professionals and students. It provides clinical information summaries, patient fact sheets, and information about toxicity and interactions as well as relevant links. The task force is a cooperative effort of the staff and students from Children’s Hospital, the Massachusetts College of Pharmacy and Health Sciences, and the Dana Farber Cancer Institute.
Related articles
- New dietary supplement label database (phlibraryres.wordpress.com)
- A Doctor’s Advice About Dietary Supplements Could Need a Vitamin Boost (medindia.net)
- Dietary Supplements! (nopalifeblog.wordpress.com)
- Many Docs Don’t Discuss Dietary Supplements, Study Says (nlm.nih.gov)
- FDA warns on vitamin supplement containing steroids, cites risks (foxnews.com)
- Doctor-Patient Communication About Dietary Supplements Could Use a Vitamin Boost (familyhealthnewsonline.com)
- FDA warns of steroids in vitamin B supplement (nbcnews.com)
Herbal medicine: 6 tips to consider when talking to your patients

Pictures of herb samples from categories of Chinese Herbs Substances for Topical Application (Photo credit: Wikipedia)
From the 4 July 2013 article at KevinMD.com
ROBIN FRIEDLANDER, MD | MEDS | JULY 4, 2013
Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little room for nuance.
In Western medicine, at best, herbs and plants are recognized for their role as an anchor ingredient in many pharmaceutical drugs. At worst, herbs are shunned for being unstudied and unregulated – fraught with reports of contamination, false-advertising and misuse by patients. This is thanks in large part to the Dietary Supplement Act of 1994, which allowed their sale without prescription.
Yet at least 15 million Americans say they take some form of herbal medication, and the dietary supplement market grosses $28 billion dollars annually. In other words, chances are that some of your patients are taking herbs, whether you know it or not.
First, some context: Not all herbs are restricted to mysterious Internet sites or eight hour energy drinks. Far from it. Tumeric root, a staple in Indian food, is a great example of an herbal medicine whose active ingredient, curcumin, has been proven to have anti-inflammatory, antioxidant, adaptogenic, and immunomodulatory properties. Not only has it been widely studied and used, but it also has basically no side-effects.
Ginger, cinnamon, not to mention others less likely to show up in your salad – milk thistle, for example – all have double-blind studies backing their claims. Indeed, many herbs can be a great sources of antioxidants, phytonutrients, and alkaloids, and have properties ranging from the anti-microbial to the anxiolytic. These anti-inflammatory properties can lend them a supportive role in the continuum of health and illness, helping nourish the body properly so it can do what it was designed to do – heal from and resist disease.
So how do you, as a Western doctor, with a responsibility to do no harm, approach herbs intelligently? The following is a pathway for addressing the use of herbal medicine in your practice even if you would never recommend an herb yourself.
1. Do your research. I find that the most easy-to-use and comprehensive guides are the online databases The Natural Standard, and The Natural Medicines Comprehensive Database, as well as the textbook, The Essential Guide to Herbal Safety. For a quick reference, the National Institutes of Health also offers the online“Herbs At A Glance,” patient-focused resource with information on the most common Western herbs. Finally, the American Journal of Cardiology published two helpful lists in 2010 summarizing common herb-drug interactions and herbs to avoid in patients with cardiovascular diseases. The databases and textbook in particular offer a digestible run-down of efficacy, contraindications, side effects, drug interactions, and pregnancy classification.
Related Resources
Related articles
- University of Ibadan to begin course on Herbal Medicine (whatsupibadan.com)
Herbal and Dietary Supplements Can Adversely Affect Prescribed Drugs, Says Extensive Review

Dietary supplements, such as the vitamin B supplement show above, are typically sold in pill form. (Photo credit: Wikipedia)
Those of you who follow this blog know I continually harp on the necessity of sharing your use of complementary/alternative therapies as well as supplements with your health care providers.
From the 24 October 2012 article at ScienceDaily
A number of herbs and dietary supplements (HDS) can cause potentially harmful drug interactions, particularly among people receiving medication for problems with their central nervous or cardiovascular systems.
Those are the key findings of an extensive research review published in the November issue of IJCP, theInternational Journal of Clinical Practice.***
Researchers examined 54 review articles and 31 original studies. They found that the greatest problems were caused by interactions between prescribed drugs and HDS that included ingredients such as St John’s Wort, magnesium, calcium, iron or ginkgo.
“Consumer use of HDS has risen dramatically over the past two decades” says co-author Dr Hsiang-Wen Lin from the College of Pharmacy, China Medical School, Taiwan.
“In the USA, for example, it is estimated that more than 50 per cent of patients with chronic diseases or cancer use them and that many patients take them at the same time as prescribed medication.
“Despite their widespread use, the potential risks associated with combining HDS with other medications, which include mild-to-severe heart problems, chest pain, abdominal pain and headache, are poorly understood.”
Key findings of the review included:
- The literature covered 213 HDS entities and 509 prescribed medications, with 882 HDS-drug interactions described in terms of their mechanisms and severity.
- Warfarin, insulin, aspirin digoxin and ticlopidine had the greatest number of reported interactions with HDS.
- More than 42 per cent of the drug interactions were caused by the HDS altering the pharmacokinetics of the prescribed drugs — the process by which a drug is absorbed, distributed, metabolised and eliminated by the body.
- Just over 26 per cent of the total were described as major interactions.
- Among the 152 identified contraindications, the most frequent involved the gastrointestinal system (16.4%), neurological system (14.5%) and andrenal ⁄ genitourinary diseases (12.5%).
- Flaxseed, echinacea and yohimbe had the largest number of documented contraindications.
Related Resources
- Evaluating Health Information (links at Health/Medical News and Resources by yours truly)
- Drugs, Supplements, and Herbal Information (MedlinePlus)Learn about your prescription drugs and over-the-counter medicines. Includes side effects, dosage, special precautions, and more.Browse dietary supplements and herbal remedies to learn about their effectiveness, usual dosage, and drug interactions.
- Dietary Supplements Label Database (US National Library of Medicine) offers information about label ingredients in more than 6,000 selected brands of dietary supplements. It enables users to compare label ingredients in different brands. Information is also provided on the “structure/function” claims made by manufacturers. These claims by manufacturers have not been evaluated by the Food and Drug Administration. Companies may not market as dietary supplements any products that are intended to diagnose, treat, cure or prevent …
- Drugs and Supplements (sponsored by the Mayo Clinic) Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals. Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
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- NIH launches free database of drugs associated with liver injury (jflahiff.wordpress.com)
- Tips for Older Dietary Supplement Users (nutritionucgiblog.com)
- FDA warns of dangerous dietary supplements (thechart.blogs.cnn.com)
**Unfortunately this article is only available through paid subscription.
Ask for an available copy at your local public, academic, or medical library. (Many academic and medical libraries will help anyone who walks in, call ahead and ask for a reference librarian)
If your library does not have it, ask about Interlibrary loan. You may be able to get a copy from another library at little or no cost.
Traditional Chinese Medicines – Some Are Dangerous
As I’ve stated in previous postings here, choose your alternative/traditional/complementary medicines and therapies wisely.
Also, include herbs, supplements and traditional medicines in “medications” lists you share with your healthcare provider, pharmacist, or any healthcare professional you are consulting. Many of these non-prescription items can interfere with any prescription medicine you are taking.
The Related Resources section below has links to trusted resources. However, they are not meant to replace advice from you health care provider.
From the 14 April 2012 article at Medical News Today
Australian border officials seized 15 TCMs (traditional Chinese medicines), which researchers from the Murdoch University analyzed to reveal the animal and plant composition by using new DNA sequencing technology. The results, published in PLoS Genetics, showed that some of the analyzed TCM samples contained potentially toxic plant ingredients, allergens, as well as traces of endangered animals.Leading researcher, Dr. Bunce, and a Murdoch University Australian Research Council Future Fellow commented:
“TCMs have a long cultural history, but today consumers need to be aware of the legal and health safety issues before adopting them as a treatment option.”
Related Resources
- Drugs, Supplements, and Herbal Information (from a MedlinePlus page)
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists
- HerbMed®
an interactive, electronic herbal database – provides hyperlinked access to the scientific data underlying the use of herbs for health. It is an impartial, evidence-based information resource provided by the nonprofit Alternative Medicine Foundation, Inc. This public site provides access to 20 of the most popular herbs.- Herbs at a Glance (US National Center for Complementary and Alternative Medicine)
a series of fact sheets that provides basic information about specific herbs or botanicals—common names, uses, potential side effects, and resources for more information.- Herbal Links
a compilation of sites that the researchers at the University of Iowa Drug Information Service consider to be the highest quality and most useful to pharmacists for finding information concerning herbal medicines.
Longwood Herbal Task Force
This site has in-depth monographs about herbal products and supplements written by health professionals and students. It provides clinical information summaries, patient fact sheets, and information about toxicity and interactions as well as relevant links. The task force is a cooperative effort of the staff and students from Children’s Hospital, the Massachusetts College of Pharmacy and Health Sciences, and the Dana Farber Cancer Institute. Drug Information Portal (US National Library of Medicine)
Search by drug. Information includes some basic resources (as that at MedlinePlus) plus some more technical ones (as Toxilogical Data and Literature)- Dietary Supplements Labels Database Information about label ingredients in more than 6,000 selected brands of dietary supplements. It enables users to compare label ingredients in different brands. Information is also provided on the “structure/function” claims made by manufacturers.These claims by manufacturers have not been evaluated by the Food and Drug Administration. Companies may not market as dietary supplements any products that are intended to diagnose, treat, cure or prevent any disease.
- NCCAM Director’s Page – It’s Time to Talk (March 13, 2012)
- Time to Talk is a recently launched NCAAM series which encourages folks to discuss complementary health practices with their health care providersThe director notes the following
- We know that nearly 40 percent of Americans use some kind of complementary health practice. But we also know that most patients do not proactively disclose use of complementary health practices to their health care providers. Likewise, most providers don’t initiate the discussion with their patients. As a physician, I strongly believe that patients and their health care providers need to talk openly about all of their health care practices to ensure safe, coordinated care. Talking not only allows fully integrated care, but it also minimizes risks of interactions with a patient’s conventional treatments.
- This month’s Time to Talk includes these tips
- List the complementary health practices you use on your patient history form. When completing the patient history form, be sure to include everything you use—from acupuncture to zinc. It’s important to give health care providers a full picture of what you do to manage your health.
- At each visit, be sure to tell your providers about what complementary health approaches you are using. Don’t forget to include over-the-counter and prescription medicines, as well as dietary and herbal supplements. Make a list in advance, or download and print this wallet card and take it with you. Some complementary health approaches can have an effect on conventional medicine, so your provider needs to know.
- If you are considering a new complementary health practice, ask questions. Ask your health care providers about its safety, effectiveness, and possible interactions with medications (both prescription and nonprescription).
Related articles
- Chinese herbal medicines contained toxic mix (cbc.ca)
- Chinese herbal medicines contained toxic mix – CBC.ca (drugstoresource.wordpress.com)
- Traditional Chinese Medicines Linked to Cancer [Medicine] (io9.com)
- Chinese medicines contain traces of endangered animals (telegraph.co.uk)
- Breaking down traditional Chinese medicine. (green.blogs.nytimes.com)
- Dangers of Chinese Medicine Brought to Light by DNA Studies (news.sciencemag.org)
- Dangers of Chinese Medicine Brought to Light by DNA Studies (news.sciencemag.org)
Popular herbal supplements may adversely affect chemotherapy treatment
Doctors urge cancer patients to discuss supplements with their doctors before beginning treatment
(Northwestern Memorial Hospital) Acai berry, cumin, herbal tea, turmeric and long-term use of garlic — all herbal supplements commonly believed to be beneficial to your health — may negatively impact chemotherapy treatment according to a new report…
…
Herbal supplements, defined as plant or plant parts used for therapeutic purposes, can interact with chemotherapy drugs through different mechanisms. Some herbs can interfere with the metabolism of the drugs, making them less effective while other herbs such as long-term use of garlic may increase the risk of bleeding during surgery. While culinary herbs used in small quantities for flavoring are generally safe, consuming large amounts for prolonged periods of time may have a negative effect on the body when going through chemotherapy.
Buyer Beware: Herbal Products Missing Key Safety Information
From the 8 August 2011 Science Daily article
Many herbal remedies available over-the-counter in pharmacies and health food shops are still lacking important information needed for safe use, according to University of Leeds researchers.
In April this year, a new EU law came into force regulating the sale of traditional herbal medicines, such as St John’s wort and Echinacea. These products must now contain clear information on possible side effects, how they could interact with other prescribed medicines and whether people with existing illnesses should take them or not. They are clearly marked with the THR logo showing they have ‘Traditional Herbal Registration’.
However, a number of popular herbal remedies, such as Asian ginseng and ginkgo, may not be covered by this law and could be missing key details on their safe use. Also, existing stocks on the shelves of shops and pharmacies, produced before the law came into force, can still be bought and will not have the new clear safety information….
Read entire Science Daily news article
Related articles
- Do You Use Herbal Remedies? (fitsugar.com)
- Traditional Herbal Medicines Banned in EU (beinghealthyhomeandaway.blogspot.com)
- Study Questions Giving Babies Botanical Supplements, Teas (jflahiff.wordpress.com)
- Antioxidants: Beyond the Hype & Dietary Supplement Web Sites(jflahiff.wordpress.com)
- Herbs at a Glance: A Quick Guide to Herbal Supplements(jflahiff.wordpress.com)
AHRQ Releases Tool to Help Consumers Reduce Medication Errors
From the press release
Three out of four Americans are not following their doctor’s advice when it comes to taking prescription medication, according to U.S. Surgeon General Dr. Regina Benjamin. AHRQ and the National Council on Patient Information and Education have released a revised guide to help patients learn more about how to take medicines safely. “Your Medicines: Be Smart. Be Safe” is a booklet that includes a detachable, wallet-sized card that can be personalized to help patients keep track of all medicines they are taking, including vitamins and herbal and other dietary supplements. Available in English and Spanish, the guide includes questions that patients can ask their doctors about their medications. Select to access a copy of the guide. Print copies are available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.
Herbs at a Glance – Sage
The National Center for Complementary and Alternative Medicine has published a new Herbs at a Glance fact sheet focusing on Sage.
A few herb related Web sites
Information about ingredients in more than three thousand selected brands of dietary supplements. It enables users to determine what ingredients are in specific brands and to compare ingredients in different brands. Information is also provided on the health benefits claimed by manufacturers. These claims by manufacturers have not been evaluated by the Food and Drug Administration. Check out the Help section for tips on how to browse and search this site.
This noncommercial consumer health and drug information site provides information about drugs and treatment options to be discussed with your primary health care provider or a pharmacist. Information about over 1,500 drugs as well as common herbs and supplements. The check interactions tab (potential interactions between drugs) and conditions/treatments area provide easy-to-read overviews. Information provided by Drawing pharmacy experts, licensed doctors of pharmacy, and physicians. From ExpressScripts.
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
- Drugs and Supplements (sponsored by the Mayo Clinic)
Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals.
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
- Natural & Alternative Treatments**
Contains detailed information on almost 200 different conditions and the conventional and natural treatments used to treat them, over 300 herbs and supplements, plus drug-herb and drug-supplement interactions for more than 90 drug categories.
Herbs at a Glance: A Quick Guide to Herbal Supplements
Herbs at a glance: a quick guide to herbal supplements is a 100 page indexed PDF document which gives the basics on the most common herbs in dietary supplements – historical uses, what they are used for now, scientific evidence on effectiveness, and potential side effects.
It is published by the US National Center for Complementary and Alternative Medicine (NCAAM).
The NCAAM Web site includes links to information under titles as
- Health Topics A-Z with Evidence-based information on treatments and conditions
- Information for Consumers with numerous fact sheets to help you decide if complementary/alternative medicine is right for you. (Don’t forget to consult with your health care providers! These fact sheets can be great discussion starters)
- A good introductory page on What is Complementary and Alternative Medicine?
- News and Events
- Ways to get updates bv email, newsfeed (RSS), Twitter, Facebook, and Youtube
A few related Web sites
- Complementary and Alternative Medicine (MedlinePlus)has links to overviews, specific conditions, tutorials, videos, research, and more
- Herbal Medicine (MedlinePlus) has links to overviews, specific conditions, research, and more
- Complementary Medicine (NetWellness) has links to general information,treatment, and Ask-An-Expert answered questions. One can ask a question at this site, and receive a reply within a few days.
- Alternative Medicine (NIH) contains links to information at US government sites
- Drug Information Portal (NIH) provides a wealth of information for consumers and professionals.
- US Office of Dietary Supplements contains fact sheets, news items, decision making guidance, consumer protection information, nutrient recommendations, and more
and a related news item…
From the December 16, 2010 Health Day news item U.S. Spending Millions to See if Herbs Truly Work
THURSDAY, Dec. 16 (HealthDay News) — People have been using herbal supplements for centuries to cure all manner of ills and improve their health. But for all the folk wisdom promoting the use of such plants as St. John’s wort and black cohosh, much about their effect on human health remains unknown.
But the federal government is spending millions of dollars to support research dedicated to separating the wheat from the chaff when it comes to herbal supplements.
“A lot of these products are widely used by the consumer, and we don’t have evidence one way or the other whether they are safe and effective,” said Marguerite Klein, director of the Botanical Research Centers Program at the U.S. National Institutes of Health. “We have a long way to go. It’s a big job.”
In August, the U.S. National Center for Complementary and Alternative Medicine and the Office of Dietary Supplements awarded about $37 million in grants to five interdisciplinary and collaborative dietary supplement centers across the nation. The grants were part of a decade-long initiative that so far has awarded more than $250 million toward research to look into the safety and efficacy of health products made from the stems, seeds, leaves, bark and flowers of plants.
Reliance on botanical supplements faded in the mid-20th century as doctors began to rely more and more on scientifically tested pharmaceutical drugs to treat their patients, said William Obermeyer, vice president of research for ConsumerLab.com, which tests supplement brands for quality.
But today, herbal remedies and supplements are coming back in a big way. People in the United States spent more than $5 billion on herbal and botanical dietary supplements in 2009, up 22 percent from a decade before, according to the American Botanical Council, a nonprofit research and education organization.
The increase has prompted some concern from doctors and health researchers. There are worries regarding the purity and consistency of supplements, which are not regulated as strictly as pharmaceutical drugs.
“One out of four of the dietary supplements we’ve quality-tested over the last 11 years failed,” Obermeyer said. The failure rate increases to 55 percent, he said, when considering botanical products alone.
Some products contain less than the promoted amount of the supplement in question — such as a 400-milligram capsule of echinacea containing just 250 milligrams of the herb. Other products are tainted by pesticides or heavy metals.
The U.S. Food and Drug Administration warned supplement makers on Dec. 15 that any company marketing tainted products could face criminal prosecution. The agency was specifically targeting products to promote weight loss, enhance sexual prowess or aid in body building, which it said were “masquerading as dietary supplements” and in some cases were laced with the same active ingredients as approved drugs or were close copies of those drugs or contained synthetic synthetic steroids that don’t qualify as dietary ingredients.
But even when someone takes a valid herbal supplement, it may not be as effective when taken as a pill or capsule rather than used in the manner of a folk remedy. For example, an herb normally ground into paste as part of a ceremony might lose its effectiveness if prepared using modern manufacturing methods, Obermeyer said.
“You move away from the traditional use out of convenience, and you may not have the same effect,” he said.
Researchers also are concerned that there just isn’t a lot of evidence to support the health benefits said to be gained from herbal supplements. People may be misusing them, which can lead to poor health and potential interactions with prescription drugs.
“Consumers often are taking them without telling their doctor, or taking them in lieu of going to the doctor,” Klein said……