Buyer beware: think carefully about herbs and supplements

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Has a parent or friend suggested that you take echinacea when you’ve been getting sick? Do you know someone who uses Saint-John’s-wort to treat depression? Both of those products are herbal supplements. Nearly 18 percent of American adults used “nonvitamin, nonmineral, natural products” in 2007, according to the National Health Interview Survey. Many teens and children use those products too.

Noah, 13, of Washington, is one teen who regularly takes herbs. At the first signs of a cold, Noah makes sure to drink a lot of water and get plenty of rest. But he will also drink tea made from chamomile, mint, and echinacea. “My colds don’t last very long,” Noah says.

His mother, Sheila Kingsbury, has studied herbal medicine and teaches at Bastyr University in Kenmore, Wash. She works as a doctor of naturopathy, a field that focuses on alternative treatments such as special diets and herbal medicines. For centuries, herbs have been used to treat various diseases in cultures around the world, such as those in India and China.

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What Are They?

Herbs aren’t used just in specific cultures and by alternative medicine specialists. Herbal supplements, also called botanicals, are sold in drug-stores, in health-food stores, in supermarkets, and online. In recent years, scientists have been researching whether the herbs are safe and effective. In cases in which they do seem to work, researchers would like to understand how.

Herbal supplements are made from plants. They often have labels that say “natural.” (See “Common Herbal Supplements,” on page 8.) The supplements contain chemicals–made by the plants–that can act on the body, just as the chemicals in over-the-counter or prescription drugs do.

Herbal products are classified as supplements rather than drugs, however. (See “Supplement vs. Drug.”) There are big differences between those categories, such as the amount of research needed before they’re allowed to be sold. “As a consequence, there’s really not much in the way of safety data on the package labels” of many supplements, says Gail Mahady, an assistant professor in the College of Pharmacy at the University of Illinois at Chicago.

The labeling on a supplement is pretty simple, she points out. It might not include much more information than the daily dose. For that reason, according to Mahady, it’s important to become knowledgeable about both what you’re using and why you want to use it.

Should You Use Them?

Be aware that not all supplements work as promised. Weight-loss supplements are rarely, if ever, effective, says Kingsbury. “They can never substitute for exercise and good nutrition,” she adds.

And some supplements, such as the traditional Chinese remedy ephedra, have been shown to be harmful. The U.S. Food and Drug Administration took ephedra off the market in 2004 after numerous people became ill or died. The supplement stressed the circulatory system, raising the risk of a heart attack or stroke. “Just because [herbal supplements are] natural doesn’t mean that they’re necessarily safe,” says Dr. Susan Yussman, a physician who specializes in adolescent medicine at the University of Rochester in New York.

Because herbal products contain active chemicals, they can have side effects, just as other medications do. For instance, ginkgo biloba can increase the risk of bleeding. And supplements can interact with other drugs that you might be taking. Saint-John’s-wort, for example, interferes with many drugs that are processed in the liver, including some used to treat epilepsy and asthma. If you’re taking a prescription drug and a supplement at the same time, you need to be especially careful, says Mahady.

 

Get the Facts

Are you thinking about using an herbal supplement? If so, look for scientific information about it from reliable sources. You need to learn about the product’s ingredients, how it’s made, possible allergic reactions, and ways the herb might interact with other medicines that you’re taking.

Talk with your doctor, advises Yussman. If your doctor doesn’t know the answers to your questions right away, he or she can look them up. Talk to your parents too, she adds. They might be able to help you get more information. A pharmacist should also understand the interactions between common herbal supplements and other medications, says Mahady.

Good medical advice is especially important if you have a chronic condition, such as diabetes, epilepsy, irritable bowel syndrome, or attention-deficit hyperactivity disorder, says Mahady. A supplement might interfere with your medications or cause additional side effects. Do you have allergies? If you’re allergic to some types of plants, you could react to an herbal supplement. For example, if you’re allergic to ragweed, you might react to echinacea.

A good starting point for learning about these products is the Web sites named in “Science-Based Supplement Information.” Be particularly careful of where you’re getting your facts, says Mahady. The Internet doesn’t always have reliable information, and supplements that work for your friends might not be right for you.

Even when there is some scientific evidence of success, such as Saint-John’s-wort for certain types of depression, Kingsbury advises against relying solely on an herb. If you’re depressed, you need support from a medical professional, she says. Saint-John’s-wort can also interfere with antidepressants and cause side effects, warns Mahady.

Speak Up

One challenge, Yussman says, is that doctors don’t always know what supplements a teen might be taking. Maybe your doctor hasn’t specifically asked you whether you use herbs and supplements, she says. Maybe you haven’t volunteered that information to your doctor, either.

“Sometimes teenagers feel like their doctors aren’t going to approve of it,” Yussman says. But many doctors are open to talking about it. Good communication can help you make good decisions and avoid potential problems, so if you’re using supplements, keep your doctor in the loop.

Supplement Vs. Drug

Regulation is one major difference between drugs and supplements. With drugs–both those sold over the counter and with a prescription–the U.S. Food and Drug Administration (FDA) reviews the science to help ensure that a drug is safe and effective before it’s allowed to be sold. But according to a 1994 law, manufacturers don’t have to demonstrate that a dietary supplement works or is safe before marketing the product. That means the FDA can stop a supplement from being sold only after it’s shown to be unsafe. Supplements are assumed to be safe because people have used them in the past, says Gail Mahady, an assistant professor of pharmacy at the University of Illinois at Chicago. Congress recently discussed strengthening the regulations on supplements.

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Science-Based Supplement Information

If you’re looking for information about herbal supplements, the Internet is a great resource. But always remember that not everything you read online is reliable. The trick is finding sources and solid facts you can trust. Dr. Susan Yussman of the University of Rochester recommends these Web sites with science-based information:

www.nccam,nih.gov

The National Institutes of Health provides health information about herbal supplements and other types of complementary and alternative medicine.

www.medlineplus.gov

You can search for information about supplements and other medications at the National Library of Medicine’s MedlinePlus.

Think About It

Should teens be able to buy herbs and supplements on their own? Or should those products be off-limits to anyone younger than age 18? Explain your opinion.

Key Points

* Herbal supplements are plant-based substances some people use to improve their health.

* Supplements are not considered drugs and are regulated differently.

* Evidence supports the health benefits of some supplements, but not all of them.

* Supplements do have health risks and should be used only with a doctor’s guidance.

Think and Discuss

* What are the differences between drugs and supplements?

* What should teens know about taking supplements?

* What are good ways of getting more information about supplements?

Extension Activity

Besides herbal supplements, people use a wide range of complementary and alternative treatments. Have your class research some of them, such as meditation, chiropractic, acupuncture, and homeopathy. Then instruct them to apply the same critical-thinking skills demonstrated in the article to the other treatments.

Resources

* Dietary Supplements  Labels Database dietarysupplements.nlm.nih.gov/ dietary

* Office of Dietary Supplements www.ods.od.nih.gov

* Vitamins, Herbs, Minerals & Supplements: The Complete Guide, by H. Winter Griffith, M.D. (Da Capo Press, 2000)

COMMON HERBAL SUPPLEMENTS

Supplement   Plant               Common use     The science says ...

Echinacea    Echinacea           To prevent     Some studies have found
             angustifolia,       or treat the   that echinacea can
             Echinacea pallida,  common cold    prevent colds or make
             Echinacea purpurea                 them go away faster.
             (American                          But those studies
             coneflower)                        aren't authoritative.
                                                More research is
                                                needed. Echinacea is
                                                not recommended for
                                                kids younger than 11.

Ginkgo       Ginkgo biloba       To improve     Research has shown that
biloba                           memory and     ginkgo may be helpful
                                 concentration  for people who have
                                                Alzheimer's disease.
                                                But it's not yet
                                                settled how well the
                                                herb enhances the
                                                memory of healthy
                                                people. Ginkgo is
                                                linked to bleeding
                                                problems.

Ginseng      Panoxginseng        To boost the   A few studies suggest
             (other names:       immune system  that ginseng may help
             American ginseng,                  keep the im mune system
             Asian ginseng)                     working properly, but
                                                more research is neces
                                                sary. People who have
                                                problems with their
                                                blood pressure or blood
                                                sugar should be careful
                                                when using ginseng.

Saint-       Hypericum           To treat       Saint-John's-wort does
John's-wort  perforatum          depression     appear to temporarily
                                                ease mild cases of
                                                depression, but more
                                                research is needed to
                                                prove whether it helps
                                                in serious cases. The
                                                herb can cause reac
                                                tions with many drugs
                                                and other herbal
                                                supplements, so talking
                                                to a doctor or
                                                pharmacist before using
                                                it is essential.

Source: MedlinePlus (www.medlineplus.gov)
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