Good For You
HERBS and other dietary supplements are more popular than ever, a $15-billion-a-year industry in the United States. But, who's minding the store?
Check safety before
taking any herbals
There is no systematic evaluation of the safety of products marketed as dietary supplements. Published studies on the safety of these products are scarce. There is no systematic collection and review of adverse reaction reports for them.
Furthermore, physicians rarely seek information about patients' use of supplements.
A weight-loss preparation containing aristolochic acid is charged with damaging the kidneys of more than a hundred patients in Belgium and is suspected of causing 18 reported cases of urinary system cancer. As of last week, products containing aristolochic acid were available in the United States.
"The 1994 Dietary Supplement Act does not require that dietary supplements be shown to be safe or effective before they are marketed. The FDA does not scrutinize a dietary supplement before it enters the marketplace. The agency is permitted to restrict a substance if it poses a 'significant and unreasonable risk' under the conditions of use on the label or as commonly consumed," Dr. David Kessler, former head of the FDA, wrote in an editorial published in the New England Journal of Medicine.
"The safety standard may sound as if the FDA has all the authority it needs to protect the public. The problem is that the burden of proof lies with the FDA. Even when the agency is able to act, how is it supposed to know which products contain aristolochic acid, and who sells them?" Kessler added.
The FDA announced it will stop the importation of herbs in the Aristolochia family. To further protect consumers, the FDA contacted dietary supplement manufacturers urging that they test certain botanical products for aristolochic acid. Physicians were also alerted to the problem, in hope that they would monitor patients with unexplained kidney failure.
If you check the label of the herbal products you are using and you don't see aristolochic acid listed among the ingredients, are you free from harm?
NOT exactly. Because herbs in the Aristolochia family have a wide variety of names, it is not always easy to see if a product contains the toxic substance. Warnings and safety information on herbs, including a list of dietary supplements known to or suspected to contain aristolochic acid, can be found at http://www.fda.gov/opacom/hpwhats.html by clicking on "Dietary Supplements."
While many herbs and botanicals may be safe and effective, some can cause serious health problems or may interact with medications to produce dangerous side effects. According to Cornell University editors of "The Science of Eating Right: Vitamins, Minerals, and Dietary Supplements," these supplements should be avoided: aconite, belladonna, blue cohosh, borage, broom, burdock, chaparral, comfrey, ephedra (ma huang), germander, jin bu huan, kombucha tea, lobelia, pennyroyal, poke root, sassafras, scullcap, sleeping buddha, stephania and magnolia, tryptophan, wormwood and yohimbe.
Before you take an herbal product, the editors suggest that you investigate its potential side effects and possible interactions with drugs or other herbs. Look for standardized extracts. Choose good brands. Buy single-herb products. Do not exceed the dose recommended on the label. And, be watchful for side effects.
"The Science of Eating Right: Vitamin, Minerals, and Dietary Supplements" is a special report of Cornell University's "Women's Health Advisor." For a copy, call 1-800-571-1555.
Barbara Burke is a Hawaii-Pacific University instructor
who has been teaching and writing about food
and nutrition since 1975.