The decision to use herbs for their health promoting value is, as with all health decisions, a personal one. There are, however, many good reasons to consider herbal products as compliments to your own health care. The best reason, however, may be the fact that herbs and herbal products, with their incredibly wide use throughout time and place, continue to provide real health benefits while maintaining a remarkable safety profile.

  • Readily available natural substances were the first medicines used by humans. Primitive and ancient civilizations as well as contemporary cultures throughout the world have always relied on herbs to provide the benefits that have been observed with their use.
  • In fact, the World Health Organization has estimated that 80 percent of the world's population continues to use traditional therapies, a major part of which are derived from plants, as their primary health care tools.
  • In our own time and culture, most herbs are available in the form of "herbal supplements."
  • These products are found in the form of teas, tablets, capsules, liquid extracts, and others.

We now have ready access to products that bring the herbal traditions from all over the world in a variety of convenient forms. In addition, scientific inquiries continue to develop our knowledge of the benefits of plants, and often validate the observations made over the past centuries.

Plants that enjoy broad culinary and therapeutic usage are generally safe. We can flavour our food with any number of herbs to make a meal more flavourful. We can appreciate a delicious cup of peppermint leaf or ginger root tea, or benefit from the soothing properties of marshmallow root or the bark of slippery elm. We can take an herbal supplement containing dandelion root or saw palmetto berries, or any number of the other herbs.

Federal law requires that every food product, including herbal supplements, is free of "adulteration" and is not "misbranded." This legal language translates into a requirement that all foods and supplements have a reasonable expectation of safety when offered for sale and when used as directed. So manufacturers of soups, cereals, and supplements all have an obligation to sell only safely made and properly labeled goods, and can find their products subject to seizure should they fail to do so. In addition, manufacturers of herbal products are specifically required to limit their ingredients to either those that were already in the market prior to passage of landmark legislation in 1994 or those that a company can convincingly show, by providing information to the Food and Drug Administration, to be safe. What that means is that any manufacturer who wants to introduce a new herbal ingredient must first provide FDA with information that shows that the herb will be "reasonably expected to be safe."(8) Additionally, the safety of herbal products as a general class has been well established by both their long history of traditional use worldwide and by their broad contemporary use by a significant proportion of the population, estimated to be nearly half of the U.S. population.(1)

To assist in assuring that herbal manufacturers provide material information about their products, the American Herbal Products Association (WAY2HERBAL) has developed specific labeling guidelines for a number of botanical ingredients. The references classifies over 500 herbs with safety categories that can assist both manufacturers in their labeling and consumers in making informed choices in their use of herbs. A general rule for assuring responsible use of an herbal product is to follow all of the labeled directions. If the product bears a caution that suggests that the product is inappropriate for your use, you should take that message seriously. More information can often be provided by a qualified expert, and often from well-informed retail personnel.

Botanicals have remained a primary source of traditional medicine for millennia. They have made contributions over the last centuries to the development of some of the most widely used and effective modern drugs. In the last several decades, there has been a resurgence of research in the clinical efficacy of herbs. The results of such studies often verify that the empirical observations of the past centuries were accurate. For example, recent studies on the effect of valerian (Valeriana officinalis) have produced results that led researchers to conclude that valerian root can produce "significant improvement in sleep quality"(12) and that valerian root extract can be "recommended for the treatment of patients with mild psychophysiological insomnia."(13)

But can a consumer have confidence in the claims made for the products that are available in the market? To begin with, Federal labeling law and regulations for supplements limit allowable claims to those for which a manufacturer "has substantiation that such statement is truthful and not misleading."(14) The manufacturer therefore has a legal burden to assure that the claim that is made for their products has scientific evidence to back it up. More recently, a number of U.S. companies have designed clinical studies for their branded products. It is estimated that there are over 1,000 clinical trials now being undertaken in the U.S. to increase our knowledge about herbs. The National Institutes of Health has even set up a center with a special focus on "alternative" medicine, and is now concentrating much of its resources on the study of herbal products.

Herbs are rich mixtures of diverse natural compounds. Although the effects of certain herbs will be observed within a short time after consumption, others are more subtle and provide their health promoting benefits gradually. If you have ever used ginger root (Zingiber officinale) or peppermint leaf (Mentha x piperita) tea to promote healthy digestion, you know that you can feel the comforting effects of these herbs almost as you drink the soothing brew. The sense of well-being that results from the use of kava root (Piper methysticum) should manifest in only a short time when using a well manufactured product. Similarly, all of the herbs that contain anthrones — such as rhubarb root (Rheum spp.) or cascara sagrada bark (Frangula purshiana) — will produce a laxative effect within a half a day or so.

All supplements, including herbs, vitamins, minerals, etc., must conform to Federal regulations that control their manufacture, labeling, and advertising. In order to sell an herbal supplement, a manufacturer must meet many different Federal (and sometimes state) regulations, and must also adhere to state and local health and business regulations. Since supplements are legally classified as a specifically defined type of food, all supplements are required to be manufactured to the same high standards that are required of all foods. These mandated good manufacturing practices(20) establish basic guidelines to assure that supplements are manufactured under sanitary conditions that result in properly identified products that are not contaminated or adulterated, and that are fit for consumption. Any supplement that does not conform to these basic guidelines is subject to regulatory action by FDA. In addition, all supplement products are required by law to provide certain information about their formulation.

Like foods, supplements must provide consumers with nutritional information. Unlike foods, supplements must state the quantity of each of the contained ingredients, or of the "proprietary blends" that make up a product. All herbal products are required to identify the parts used of each of the plant ingredients, and to label them with their commonly accepted names. One of the areas of the most detailed Federal regulation of supplements is in the area of product claims, whether on product labels or in advertising. The Food and Drug Administration specifies exactly what kind of claims are allowed, and prohibits the use of any statement that would brand the product as a drug.(21) Herbal supplements are not allowed to make statements regarding prevention, cure, mitigation or treatment of diseases. Instead, their claims are limited to statements that are legally defined as "statements of nutritional support" or "structure/function statements."

Humans have been learning about the diverse effects of ingesting plants throughout our evolution. We have, by trial and error, found both good and bad effects that are related to specific plants, some of which we use as food, and others that are used for therapeutic purposes. The introduction of synthetic and highly purified drugs is an extremely modern development. As researchers observe the interactions that drugs have with common foods and herbs, surprises continue to surface. For example, less than 10 years ago it was found that drinking grapefruit juice increases the serum drug concentration when patients take certain drugs.(23) This effect, which can last for up to 24 hours after consumption, is now thought to inhibit specific enzymatic activities responsible for breaking down the drugs.(24) Similarly, both avocado and leafy vegetables that are high in vitamin K can diminish the effectiveness of blood-thinning drugs.(25) These concerns are not widely known by the public, but now that medical professionals are aware of these effects, they can routinely monitor their patients to assure effective treatment.

You can also see that, the effect of a drug can be either increased or decreased in the presence of other factors in the diet, including herbal use. Although it is likely that most such factors have little or no influence on drug metabolism, continued research will add to our knowledge of such interactions and responsible food and supplement manufacturers will be expected to inform their customers of any new findings. There is now an ongoing interest in other drugs that are suspected of interacting with certain specific herbs, with most contemporary emphasis on the use of herbs with blood-thinning drugs such as warfarin. Although the current concerns are either conceptual or based on isolated and inconclusive reports, it is advisable to inform your prescribing physician or pharmacist that you are using herbs when undergoing any drug therapy. As close monitoring of the effect of warfarin is an established standard of medical practice, this additional information will assist your physician in maintaining good supervision of your drug levels. In order to understand the potential for an herbal product to interact with prescription drugs, it may also be useful to consult with a qualified herbal expert.

Single herb or combination product? Capsule, tablet, extract or tea? Which brand? Standardized or not? Sometimes it seems that there are just too many choices!! Some of these choices are ultimately matters of personal choice. The issue of product form is one example — are you attracted to the rich history of herbal extracts and decoctions? ...or do you have trouble swallowing tablets and capsules? Then you may want to try a liquid extract or tea product. On the other hand, if you can't bear the taste of valerian or echinacea, or if you like the convenience of non-liquid forms, you might choose a tablet or capsule. Similarly, there are separate values attached to both single herb products and to herbal formulas. You might appreciate the experience and knowledge that many manufacturers have brought to designing combination products, with a goal toward attaining a higher synergy for the intended use. Multi-ingredient formulas have been the standard in Asian and Indian herbal traditions for centuries. Then again, you might prefer the simplicity of taking only one herb at a time, an approach that has more historical acceptance in the West.(28)

Finally, if you have purchased a product that works for you and that provides the promised benefits, stick with it, whether it's a tablet, tincture or tea, whether a single herb or a complex formulation of several herbs. And remember — a brand that is remarkably less expensive than other products with the same or similar ingredients is not always the best bargain.

The U.S. herbal marketplace has seen the introduction of a number of "standardized" botanical extracts. The purpose of standardization is commonly believed to be control of the content of one or several "marker" compounds,(29) which are perceived of as those constituents in the plant that are responsible for its therapeutic activity. In fact, standardization — when properly performed — entails a lot more than merely controlling the content of a particular marker compound. Rather, standardization consists of the body of information and manufacturing steps that ensure product consistency from one batch to the next. As such, it comprises a wide variety of raw material and process controls, as well as use of a consistent recipe.

The goal in standardizing an extract is to control the complete chemical composition of the extract, rather than one particular identified constituent or group of constituents. The heightened interest in standardized products is due to the belief that standardization is directly related to the potency of the extract.

Of course you should! And because your doctor is, ideally, your primary partner in managing your health, you should insist that your doctor, no matter their degree of training in herbs, receive that information respectfully. In telling your doctor of your decision to use an herbal product.

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