Are all herbal remedies safe?
No. Many herbal remedies can improve your health when used wisely. But even some of these have the potential for harm, especially if you're taking large doses or a synthetic version. You should know that most herbal remedies and "natural" supplements have not been thoroughly tested, a fact that hasn't prevented some companies from putting exaggerated claims on the labels. And while many of these preparations are useful and essentially harmless, a few have serious side effects and can even be fatal.
Which products are especially hazardous?
Among the supplements that federal agencies have demonstrated concerns about are DHEA, tryptophan, 5-HTP, human growth hormone, Triax, and androstenedione; even blue-green algae and creatine have come under scrutiny. Meanwhile, the following products have won spots on the Food and Drug Administration's version of the "public enemy" list. All pose serious health threats and should be avoided.
- Diet and sports supplements containing ephedra (also called ma huang). Ephedra, which is used in combination with other herbs in traditional Chinese medicine, is a decongestant and bronchodilator; its active ingredient, ephedrine, is also used in some prescription medicine. But a number of "alternative" manufacturers use ephedra in products that promise to promote weight loss (often sold as "herbal fen-phen"), boost energy, or build muscles -- uses in which the dangers far outweigh the purported benefits.
Ephedra contains a powerful amphetamine-like stimulant that can cause elevated blood pressure, irregular heartbeats, insomnia, nervousness, tremors, and headaches. Its use has also led to seizures, heart attacks, and strokes -- and some people have died as a result. (People with hypertension are at particular risk.) And by the way, although it can certainly boost energy, its reputation as a fat burner and muscle builder is undeserved. After years of reports of ephedra causing serious health consequences, then-U.S. Human Health and Services Secretary Tommy G. Thompson announced a ban on the supplement in early 2004. Thompson also urged consumers to stop taking ephedra immediately. Although the product has been banned, however, it is still being sold by unscrupulous merchants on the internet, so beware. What's more, many supplement manufacturers have replaced ephedra with an alternative substance called bitter orange. This allows them to market their products as "ephedra free", but according to the Mayo Clinic, bitter orange leads to many of the same health problems as ephedra.
- Sleeping Buddha. Although you'd never know it from the package label, this herbal insomnia remedy contains a prescription-strength sedative called estazolam. The drug can interfere with a person's ability to drive a car or operate heavy machinery, and it should never be mixed with alcohol or other sedatives. Most important, pregnant women should never take Sleeping Buddha because it can damage their unborn child. (After receiving a warning from the FDA in 1998, the distributor of Sleeping Buddha voluntarily recalled it.)
- Anything containing GBL (gamma butyrolactone). This drug is the key ingredient in many products that claim to build muscles, enhance sex, and induce sleep. Marketed as in such products as Renewtrient, Revivarant, Blue Nitro, GH Revitalizer, Gamma G, and Remforce, GBL is commonly used as a "club drug" in raves and has become one of the FDA's biggest targets. Along with its close chemical cousins GHB (gamma hydroxy butyrate) and BD (1,4 butanediol), GBL has been linked to at least 122 serious illnesses and three deaths in the United States. The side effects include vomiting, dangerously slow breathing and low heart rates, coma, and seizures.
- Yohimbe. This tree bark, believed by some to be an aphrodisiac and used to treat impotence, has been linked to suicidal behavior, psychosis, kidney failure, seizures, and death. Despite these hazards, it's available in many health food stores.
- Herbal laxatives that claim to include the weed plantain. Some of these products actually contain the herb Digitalis lanata, the source of the heart medicine digitalis. When taken improperly, this herb can cause irregular heartbeats and heart attacks.
How can I learn more about risky supplements?
It's not always easy to sort the effective herbal remedies from the dangerous frauds. You can't count on labels or the clerks at health food stores for guidance. You can, however, consult Medwatch (http://www.fda.gov/medwatch), a site that lists the FDA's latest warnings on dietary supplements as well as drugs and medical devices. You can also contact The Pharmacist's Letter (http://www.pharmacistsletter.com), which has a comprehensive Web database for subscribers containing information on herbs and supplement, including common uses, risks, and interactions with drugs and other supplements.
What precautions should I take if I want to try an herbal remedy?
The FDA recommends that you consult a medical doctor before trying any dietary supplement, especially if you're pregnant or breastfeeding, chronically ill, elderly, under the age of 18, or taking any prescription or over-the-counter medications. When choosing a supplement, look for "U.S.P." on the label. This means the manufacturer has followed the standards set by the U.S. Pharmacopoeia.
FDA warns consumers against dietary supplement products that may contain digitalis mislabeled as plantain. June 12, 1997.
FDA re-issues warning on GHB. February 18, 1997.
HHS News. June 2, 1997.
FDA warns consumers about taking sedative sleeping Buddha. March 10, 1998.
Illnesses and injuries associated with the use of selected dietary supplements. Questions and Answers about FDA's Actions on Ephedra Dietary Supplements. Dec. 30, 2003. Food and Drug Administration.
Letter to companies marketing ephedra dietary supplements. Food and Drug Administration.