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Herbal medicines: are they safe?

28 Mar 2003

In the past year, some traditional herbal medicines have been dismissed as ineffective, others banned and one even blamed for the death of a top athlete. So how safe are they?

In December 2002, the UK government banned the sale of kava-kava – a natural tranquilliser often used instead of Valium – after it was linked to four deaths. A year earlier many suppliers had voluntarily removed the product from their shelves following nearly 70 cases of liver damage around the world – seven patients needed transplants.

Then in February this year, the herbal stimulant ephedra was linked to the death of a 23-year-old baseball player in the US. A medical examiner said the athlete died from multiple organ failure due to complications from heatstroke, resulting from factors including the consumption of Xenadrine – a food additive containing ephedra.

It was just one of dozens of deaths blamed on the herb in the past four years and followed research that suggested the supplement is hundreds of times riskier than other remedies.

Just as damaging to the industry have been several studies this year that concluded traditional medicines such as echinacea (for colds) and the homeopathic remedy arnica (for reducing swelling and bruising) simply do not work. So have herbal medicines had their day?

Scare stories

Trudy Norris, president of the National Institute of Medical Herbalists, says the medicines have been used safely for the most part for thousands of years, but admits that “scare stories” can have a profound effect on people.

“There is actually a very strong safety track record for herbal medicine both in the quality and consistency of the material and with the herbal practitioners,” she says.

Indeed, the vast majority of complaints seem to arise from just a few products. Ephedra, for example, made up just 1 per cent of the herbal supplement sales in the US in 2001 yet accounted for 62 per cent of the herb-related reports to poison control centres.

Michael McIntyre, chairman of the European Herbal Practitioners Association, says the situation is unique to the US. “It’s because of the legislation in America. Ephedra is in the middle of an update,” he says. “It is a very powerful herb and should not be in a dietary supplement. No self-respecting herbalist would suggest using that.”

It’s also rather strange that many people believe modern-day drugs and pills are safe yet herbal medicine can include an element of risk. “Eighty per cent of modern drugs are derived from herbal medicines,” says Michael. Besides, many foods also act as medicines. “Watercress has a circulatory effect, garlic lowers your cholesterol and blood pressure, and lemon balm is known to help in early Alzheimer’s,” he points out.

Fatal interaction

Problems with herbal medicines are almost always due to interactions with modern drugs. “St John’s wort is a very, very safe herb – good for low mood,” says Michael. However, it acts on the enzyme system in the liver and washes out quite a large range of conventional medicine, he says.

As such, the herb can make other drugs less effective. People sometimes may not appreciate the complicated interaction, seeing St John’s wort as the sole cause of the problem, say experts.

A more dangerous example involves an everyday food – grapefruit. Michael says people have died from drinking it while also taking the anti-coagulant warfarin. Trained herbalists specialise in this interaction between herbs, drugs and the body, which is why, Michael says, people should go to see a herbalist in the same way they would consult a conventional doctor before taking any medicines.

Legal wrangling

So where does this leave the consumer? Two new pieces of legislation focusing almost entirely on the herbal medicine market are going through the European Commission and the British Parliament, which aim to make the industry safer.

Suppliers of herbal medicines may soon be required to say what their products should be used for and to include any cautions on the packaging. This would reverse a law introduced in 1968 that was intended to protect the consumer by prohibiting remedies from saying what they were good for.

Both Michael McIntyre and Trudy Norris welcome the proposed changes. Michael says a legislative platform would help herbal medicine develop and he also argues for the state registration of herbal practitioners.

With information on herbal remedies readily available and a new legitimacy given to the herbal market, not only would medicines improve but we should also be able to avoid many of the problems that have started to dog the industry.

Poisonous plants

But how safe are herbal medicines? Licensed herbal remedies in the UK can easily be identified by the PL (product licence) number on the label, and are safe although they should be taken with the same caution that you take any medication.

However, there are many unlicensed remedies for which the best advice is to do some research first – the government’s Medicines Control Agency (MCA) runs a “Herbal Safety News” page on its website that gives comprehensive advice including:

· Remember herbal remedies are medicines
· See a doctor if you think you may have reacted badly to a remedy
· Tell your doctor what remedies you take if he/she prescribes you any drugs
· Be wary of any herbalist who is unwilling to give you a full list of a remedy’s ingredients

The MCA said, “Many plants, trees, fungi and algae can be poisonous to humans. It is worth remembering that many pharmaceuticals have been developed or derived from these sources because of the powerful compounds they contain. Any medicine, including herbal remedies, which have an effect on the body should be used with care.”

Chairman of the Committee on Safety of Medicines – the independent committee of experts that advises the government on the safety, quality and efficacy of medicines – Professor Alasdair Breckenridge said, “Many herbal remedies pose little risk to public health and are valued by consumers. However, there are various reasons why herbal remedies may, on occasions, pose problems and it can be difficult for those interested to keep up-to-date on progress.

“While we cannot assure the public as to the safety of some unlicensed herbal remedies available on the market, it is right that information about herbal safety is brought to the attention of the public and the herbal sector.

Further information:

National Institute of Medical Herbalists
European Herbal Practitioners Association
The MCA’s Herbal Safety News

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