Incorporating herbal supplements into your life is pretty easy; buy them and start taking them. Consumers often aren’t aware of questions they should ask and information they should know before making that purchase. In this article we’ll be looking at some of the things consumers should consider before using herbal supplements.
Allergic reactions can range from minor annoyances to major health issues. When looking into herbal supplements, consumers need to consider if they have any plant allergies as well as any (other) food allergies.
Dealing with food allergies has become easier with the designation of major food allergens by the FDA. These are milk, egg, fish, Crustacean shellfish, tree nuts, wheat, peanuts, and soybeans. These allergens account for 90% of the food allergies that people suffer. If the manufacturer knows any of these are present in food, they must be listed on the label or packaging. For dietary supplements, any major food allergens should be listed under “other ingredients” on the label’s information panel or within the supplement facts panel. For supplement capsules and tablets, there can be binders and fillers that are soy or oat -based starches.
Dealing with herbal supplements and plant allergies is more challenging because the information isn’t so readily available. If you have an allergy to a particular plant, it is possible that you are allergic to other plants in the same plant family. One plant that people are commonly allergic to is ragweed – specifically the pollen. Ragweed belongs to the Asteraceae plant family. If you are allergic to ragweed, then you may also be allergic to chamomile and/or purple coneflower (Echinacea). You may be more likely to have reactions to plants in other families as well depending on the allergy.
Over-The-Counter and Prescription Medications
Consumers who take over-the-counter (OTC) and/or prescription medications and are interested in using herbs should be aware that there can be definite, and sometimes severe, interactions. St. John’s Wort, Valerian, Echinacea, and Yohimbe are just a few examples of herbs that can cause interactions depending on the drug(s) being used. There are three basic different types of effects that herbs can have in interaction with OTC and prescription medications as well as with other herbs.
Additive– The effect of the two active agents (herb, OTC, prescription) taken together is equal to the two taken separately. One example is taking a drug and a herb that both thin the blood; they will both act on the body. The effect of one is added to the effect of the other and may be more of an effect than is needed.
Synergistic– The effect of the two active agents taken together is greater than the two taken separately. One example is an herb can decrease how quickly a drug is metabolized in the body leaving more of the drug in the body for longer. This can lead to too much of the drug being in the body with additional doses and possibly increase side effects and toxicity.
Antagonistic – The effect of the two active agents taken together is less than the two taken separately. One example is an herb can increase how quickly a drug is metabolized in the body clearing the drug from the body before it can properly do its job.
Contamination and Adulteration
Two terms seen in relation to herbal supplements are contamination and adulteration. Contamination is the presence of foreign material that makes the original material impure. Contaminants for herbs can be things like other plants, heavy metals, pesticides, microorganisms, etc. Adulteration is the contamination of a material to the extent that it can lead to harm by the user when using the material as recommended or suggested or under ordinary conditions of use. These two terms are sometimes used interchangeably. Often adulteration is seen as the intentional addition of a foreign substance into a material, where contamination is seen as an unintentional addition.
There are two typical types of adulteration in herbal supplements:
- The addition of prescription drugs and/or other ingredients (e.g. caffeine) to boost the effect of the supplement.
- The addition of other plant material as a substitute for the initial herb because the initial herb is difficult to find and/or as a way to boost profit.
The Food and Drug Administration (FDA) oversees the regulation of herbal supplements. Part of these regulations include current good manufacturing practice (cGMP) standards that manufacturers must follow. These standards include requirements for the whole manufacturing process from personnel, physical grounds and equipment to production, quality control, labeling and packaging to handling returned product and product complaints. Testing both the crude herb material as well as the final herbal supplement is part of current good manufacturing practice (cGMP) standards to detect both contamination and adulteration.
Companies that produce herbal supplements can use different laboratory tests to identify the crude herb material and check for contaminates as well as check the final preparation for identity, purity, strength and composition. Sometimes this testing is done in-house at the company and sometimes companies hire outside laboratories to do the testing. One way companies can have control over the quality of the herbs they use is to grow their own supply. Another way is for companies to build and maintain relationships with reputable growers/suppliers that provide quality crude herbs.
The ABC-AHP-NCNPR Botanical Adulterants Program has been a recent addition to the marketplace for dealing with the adulteration issue. This program was created in late 2011 by the American Botanical Council, the American Herbal Pharmacopoeia and the University of Mississippi’s National Center for Natural Products Research. Part of its purpose is to provide herbal supplement companies with reports of adulteration of specific herb materials and information on the best types of testing for detecting certain adulterants.
As consumers, we are often only familiar with the end part of the production cycle – namely the purchasing and using part. Learning about the beginning and middle part of this cycle can help better inform consumers about what goes into creating the supplement. Ann Armbrecht is an independent film maker who is currently working on a documentary that follows medical herb plants through the supply chain from grower to consumer. She is in the research phase of her film and recently returned from visiting growers overseas. Click here to read her recent blog posting about her initial impressions of the industry from her trip.
The thing to keep in mind is that, as we covered in A Common Misconception About Herbal Supplements, the FDA does not pre-approve supplements for safety before they are released on the market. While companies are required to follow the cGMP standards, if they choose not to, their products can still end up in consumers’ hands.
So What’s a Consumer to Do?
Be aware of potential allergy issues. Your best bet if you have plant allergies and are interested in using herbs is to check with your health care practitioner. If you are not aware of having any plant allergies, it’s still useful to know what the common allergic reaction symptoms are in case you should have an issue.
For potential OTC/prescription drug/herb interactions, there are tools online to check for possible interactions between herbs and different medications (check Links to Learn More at the end of the article for links to two of them). Be aware that these tools may not include all herbs or all drugs. Checking with a health care practitioner is the best way to go. The pharmacist at your local pharmacy may also be able to help identify possible interactions.
Let your health care practitioner know of any supplements you are taking. Many doctor offices have forms that request this information and sometimes they will ask you as part of the intake for your office visit. It’s a good idea to bring the list of supplements and the amounts you take with you because it is easy to forget once you’re sitting in the exam room (as I did recently). If you are taking prescription medications, make a point to ask if there are potential interactions with any herbal supplements you are taking or may be interested in taking. Office visits these days are, unfortunately, very short and this can be easily overlooked.
Understanding about contamination and adulteration can help you understand what to look for in a herbal supplement company. Do they offer information on where they source their crude herbs, what they test for and how they test their ingredients and products? Do they follow the cGMP for dietary supplement manufacturers? Consumers can also check into specific supplement companies and products. The FDA provides their Tainted Supplements CDER page that allows you to search by product and company name for supplements that have been found to be adulterated. In addition, you can do a general search of a supplement company’s name on the FDA website to see if there have been any compliance issues with the company. There’s also the good old search engine approach for checking out a company or product, but keep in mind that companies know how to bury negative information and feedback about themselves in browser searches.
Next article – Your Liver, Herbal Supplements and Hepatotoxicity
Links to Learn More
General information on allergies and herbs as food – University of Nebraska-Lincoln Food Allergy Research and Resource Program website – Spices and Herbs
Information on precautions to take when choosing herbal supplements – The University of Chicago Medicine website – Herbal Medicine
Drug/herb interaction checker tool – The University of Maryland Medical Center website –-
Drug/herb interaction checker tool – WebMD website
Detailed regulation language – FDA website – 21 CFR, Part 111– Current good manufacturing practice in manufacturing, packaging, labeling or holding operations for dietary supplements
National Public Radio website – Toxic Lead Contaminates Some Traditional Ayurvedic Medicines (7/31/2015)
Research abstract – National Library of Medicine, Pub Med website – Heavy metal and pesticide content in commonly prescribed individual raw Chinese Herbal Medicines (9/15/2011)
Facebook page for The Sustainable Herbs Project