Web Guide to Healthcare: Supplements

 THE USE OF HERBS AND SUPPLEMENTS

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Herbal medicine, folk medicine, phytotherapy, herbology, phytomedicine, naturopathic medicine, and botanical medicine - call it what you will. These have played an integral role in the health of man for thousands and thousands of years, maintaining health and treating illness and disease.

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Long ago, when pharmaceutical companies or drug stores did not exist, people somehow survived their illnesses. Among other things, people used herbs, various foods, and other natural substances to fight disease and maintain health. It has been suggested that OTZI, the famous prehistoric "ice man," found as a frozen, well-preserved 5300-year-old mummy in the Alps, carried birch polypore mushrooms, which could have been used as antibiotics for inflammation or to try to treat his intestinal parasites.

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It is estimated that more than 50% of our pharmaceuticals today were originally derived from plants and other living organisms. For example, Tamiflu was derived from the herb star anise; guaifenesin (Mucinex) was derived from the guaiac tree; morphine and codeine were derived from the opium poppy; pseudoephedrine (Sudafed) was derived from ephedra; Umckaloabo comes from preparations of pelargonium sidoides,  aspirin comes from willow bark; Lovaza, a newer cholesterol medicine, comes from fish oil, penicillin comes from a mold, valium is a synthetic version of valerian, digitalis (an older heart medicine) originally comes from foxglove, lovastatin comes from a fungus, and warfarin (a blood thinner) originated from sweet clover to name a few. 

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When we talk about supplements, we refer to herbs and minerals, vitamins, protein, herb amino acids, and enzymes. It isn't easy to get a reasonable estimate on how many people in the US use them: Information across sources is inconsistent. What we do know is that herbal supplements are a multi-billion-dollar industry in the US, so there must be a vast number of people taking them. So why aren't they tested for efficacy and safety by the FDA (Food and Drug Administration)?

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CHOICE OF HERBS AND SUPPLEMENTS

​These pages on herbs and supplements present many different options for the support of various ailments: Over-the-counter medicines, herbal and alternative remedies, and prescription drugs (note: there is often a fine line between over-the-counter herbals and supplements because what were initially herbal formulations are being sold in pharmacies along with the over-the-counter medicines!)

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This site includes "claims" regarding medicinal herbs and supplements based on information provided by the German Commission E, the NIH and the PubMed database, Drugs.com, WebMD, RxList, Consumer Labs, NIH (National Institute of Health), and other reputable sources (see resources). These sites do not all agree on the actions and efficacy of these herbs and supplements; some of the "considered recommendations" mentioned on this site are food for thought. They are based on preliminary or traditional use evidence. But sometimes, there is a consensus among these resources agreeing that an herb or supplement works for a particular ailment or for support: When most (if not all) agree, ideally, that is probably what you want (assuming no personal allergies, drug interactions, or contraindications). What I am saying is - do your homework if you are thinking about taking any of these.

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Choosing a Good Herb or Supplement

Efficacy, Standardization, and Purity of Supplements and the FDA​

Until these substances enter the pharmaceutical industry and are assigned to a new drug class or created synthetically, the Food and Drug Administration (FDA) does not rigorously test or approve many herbs or supplements for safety, effectiveness, or standardization because they are considered “dietary supplements” under the Dietary Supplement Health and Education Act (DSHEA) of 1994, not "medicine." The FDA does not require premarket approval for dietary supplements, but it does investigate complaints and potential hazards as they arise. The FDA regulates labeling and manufacturing standards of commercial vitamins and minerals, but does not standardize their formulations.

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A big problem arises with the FDA's limited oversight of herbs and supplements that are on the market: There is no mandatory testing for purity, quality, or standardization of concentration that the public can depend on when using these. Some may contain unhealthy foreign substances like insect parts, lead, mercury, arsenic and other "interesting" ingredients. Additionally, a product may have a substandard concentration of active ingredients. This can be unhealthy (and a waste of money). As an answer, independent testing organizations have sprung up here and there - testing supplements and herbal remedies - to assure some degree of efficacy, quality, and safety. ConsumerLab, mentioned above, has been an excellent reference for me over the last several years. They discuss various supplements, their applications, applicable research, and they test herb and supplemental products for standardization and purity (this is not an advertisement).

 

​Since many herbal and supplement products have not been the subject of rigorous research studies, there is limited evidence-based information regarding their uses, efficacy, safety, and dosing. A few sites discuss some of these different aspects of herbs (though few reference specific commercial products). Since we cannot rely on the FDA for premarket evaluation of supplements, we have to turn to these other organizations for information regarding many herbs and supplements. If you want to know more about an herb or supplement, there are several reputable organizations worth mentioning here-

• ConsumerLab tests many specific herbal and supplement only those products that are voluntarily submitted to the company for analysis. This organization publishes studies and performs third-party testing on products it receives for analysis. I think this is an excellent site to help a person choose what supplements to use: They include recommendations for different brands according to their tests and take into consideration quality, appropriate concentration of an active ingredient, test it for purity and factor in the price, among other things. (They charge for a subscription but typically offer you a trial). (This is not an advertisement).

• American Botanical Council

• German Commission E (also listed on the American Botanical Council's site) provides lists, sometimes dosages, and some studies on the efficacy of certain herbs (not specific products). The German Commission E consists of physicians, scientists, pharmacologists, and toxicologists working with the German Ministry of Health to test and closely monitor non-prescription herbal products for safety and effectiveness before they are offered to the public.

• The NIH's (National Institutes of Health) National Center for Complementary and Integrative Health also publishes information about the efficacy of certain herbs but does not publish information about specific products.

• NIH Studies - The NIH, particularly through the National Center for Complementary and Integrative Health, publishes many studies about herbs and supplements. Search "NIH" and the specific herb you are looking for. The NIH also supports toxicology research through the National Toxicology Program (NTP), which investigates safety concerns related to botanical supplements.

• Epocrates - Epocrates provides clinical data on herbs and supplements, including efficacy ratings, dosing guidance, and safety information. Much of this content is available through Epocrates+, their premium subscription tier.

• WebMD offers consumer-friendly summaries of herbal uses, potential benefits, side effects, and contraindications. While it includes references to studies, it’s not a primary research source.It’s useful for general guidance but should be cross-checked with more rigorous sources for clinical decisions.

• RxList -  RxList provides detailed information on herbal supplements, including dosage, uses, side effects, drug interactions, and contraindications. For example, their entry on St. John’s Wort includes multiple dosage scenarios and interaction warnings.

• Drugs.com offers comprehensive data on herbs and supplements, including uses, dosing, contraindications, and drug interactions. It’s a reliable consumer-facing resource, though not a primary research database

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Other Things to Consider When Choosing an Herb or Supplement:

 

USP-NF and USP-NF Labelling - This may occasionally help you decide about a brand: If you are trying to decide on a specific product, you can also look for formal designations on the label: USP, NF, or USP-NF. United States Pharmacopeia and the National Formulary (NF). The USP (United States Pharmacopeia) and NF (National Formulary) are compendia of public standards for medicines, dietary supplements, and ingredients. Together, they form the USP–NF, which sets quality standards for identity, strength, purity, and labeling. These standards are not government-issued, but USP is a private nonprofit organization that collaborates closely with the FDA, and its standards are recognized under U.S. law (e.g., the Federal Food, Drug, and Cosmetic Act). Some supplement products carry a USP Verified Mark, which means they’ve voluntarily undergone testing for quality, purity, and potency. However, most herbal and dietary supplements do not carry this mark. These are not guaranteed USP verified unless the mark is on the label.

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Historical Value - 

Since many herbal "remedies" have been used by people for thousands of years to treat various ailments, some evidence may come from traditional use. That is, the efficacy of herbs in humans is sometimes supported by historical records. By citing historical data, the potential risks and benefits of a dietary supplement can often be inferred. Many European countries accept or reject herbs based on traditional use, modern testing, and significant historical accounts of value.

A lot of historical documentation and early-stage research shows promise. Numerous herbs, plants, and fungi have documented antibiotic, antifungal, antiviral, antioxidant, and anti-inflammatory properties (among others). The antiviral testing is especially interesting, given that while we have many antibacterial medications (antibiotics) available today, we have relatively few antivirals. 

It is important to note that, over time, studies have shown that while some herbs may work as claimed, others may not. Some are marketed as miracle cures—claiming to prevent or treat nearly everything—when, in fact, they do not.

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**Some of these "herbs" and supplements really do help some medical conditions. There is a place in the world now and in the future for some of these. Many herbs are available to us with antibiotics and, especially, antiviral properties. There are somewhere around 90 antiviral drugs available as prescriptions in our country (about one-third of which are HIV antivirals). During a time of increasing resistance and incidence of disease, it would be prudent for an organization to investigate the herbals as alternative approaches and share that information with the public. ​

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In essence, many supplements sold by companies remain untested—we do not know their purity, standardization, or efficacy, so look for third-party reviews. Also, beware of companies that claim A+ products. Some of them "test" their own products and give their own companies accolades and awards.

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What a shame that, in our country, there is no easily accessible information for people regarding the testing for standardization, efficacy, and safety profiles of supplements. Many other countries have this information readily available.

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How to Use This Herbal/Supplement Information on This Site​

The pages on this site about herbs and supplements contain much information about herbs and supplements for various conditions. Because an herb is listed does not mean it has been tested, and because it is listed, it does not mean it will work. Some of them may be contraindicated and even potentially harmful (especially if not used correctly).

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Suppose you are interested in one of these herbs for treating a specific condition. As mentioned above - and I cannot stress this enough - please read more information about it. Explore reputable reviews and research located on the sites mentioned above. Before taking them, please pay particular attention to:

• Exact Names - Most pages here, about herbs and supplements, mention Latin names for the substance (some have many other names not currently included here). If you choose to use a supplement, be sure you match the correct Latin name of the herb listed with the product you choose to use. For example, "basil" is not the same as "holy basil". Look for the area in which they were grown and the part of the plant from which they are made. Those things can make a difference.

• Dosages - Because many supplements are not well-studied, standard dosages are often not readily available. For this reason, the prepackaged forms, the teas, and the oils are the easiest to use because they come with predetermined dosages; otherwise, check the sources above.

• Check the Preparation and Route - Pills, capsules, teas, elixirs, powders, fresh or dried plants, creams, gels, and lotions may all be used differently (many herbs have an essential oil equivalent).

• Routes

• Side effects

• Contraindications

• Potential interactions with your other medications (including supplements). 

• The Part of the Plant (root, stem, flower) from which that herb or supplement is made. The amount of the active ingredient can vary depending on the particular plant, the route, the part of the plant used

• The Region Where It was Grown (often not available) - The amount of the active ingredient can vary depending on where the plant was grown

• The amount of active ingredient in a particular brand (not usually available on the packaging) - Some of these can be found at the ConsumerLab Website (paid subscription with trial) (this is not an advertisement). Evaluating the amount of an active ingredient in a raw herb or plant product is difficult for the layman.

• Who is selling it? Sometimes people sell counterfeits. The ad you are reading should mention that it comes from the manufacturer/distributor or will tell you to visit their store, i.e. A GNC ad will say "visit the GNC store". I do use Amazon. You want to check the ad before purchasing. 

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Important Additional Information

​​While the action of most herbs and supplements is not guaranteed (it is a rare day when even a pharmaceutical company guarantees any prescribed medicine!). A person might find one or two supplements worth trying,  especially if other medications do not work optimally, they are too expensive, if that person does not like pharmaceutical products, or when all else fails. 

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If you are trying a new herb, it is good to start at the low end of the recommended dosage and increase if needed, but do not exceed the recommended dosages. While plants may seem innocuous because they are "just plants" they can be harmful and toxic.

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If you try an herbal remedy to treat a chronic illness, it is extremely important to discuss it with your healthcare provider. For example, suppose you have a chronic or potentially life-threatening condition like cancer,  hypertension, diabetes, COPD, very high cholesterol or triglycerides, infectious diseases (HIV, STD/STIs, Tuberculosis), or an immune disease. In that case, you need to discuss the use of particular herbs and/or supplements with your healthcare provider. You do not want to be taking the wrong path to treat your illness. My primary care provider is a good example of supplemental use in disease. He is well-read and up-to-date on medicine, herbs, and supplements. He prescribes conventional medicine and supplemental remedies, which are fantastic and practical. Some of these may not replace your medication but might work in tandem with it to optimize its effects (for example, omega-3 oil and a statin for cholesterol).

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​​​Again, refrain from jumping into taking any of these things. Do your research, choose a good brand, follow instructions, and report any herbal use to your healthcare provider.

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If you are planning to have surgery, be sure to discuss any herbs or supplements you are taking with your surgeon or anesthesiologist. Some herbs can cause excessive bleeding and are contraindicated in surgery. 

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If you have any significant plant allergies (especially to ragweed or daisies) please check to see if you have a contraindication to the herb or plant you are considering.

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If you want to use these herbal remedies for colds, sore throats, wellness support, or whatever else you have in mind, they can be hard to come by at the last minute. For a rainy day, you may want to keep some teas, oils, and other herbs or supplements on hand. 

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Cold remedies aside, some supplements require several weeks before they begin to work. Be patient. Often, the time-frame is explained with the product.

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Again, THIS IS NOT A SITE TO BE USED BY PREGNANT OR NURSING PEOPLE OF FOR THOSE UNDER 12 YEARS. 

In pregnancy, you absolutely need to check with your ob-gyn if you plan to or are taking herbs and/or supplements. Some of these can cause birth defects and miscarriage.

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Note: 

Because the FDA does not regulate supplements, they demand that sellers (and writers) refer to them as "dietary supplements," "remedies," or "support" for respective illnesses. The FDA does not allow us to make medicinal claims. Supplements cannot be called herbal "treatments" or "medicines". For these reasons, when writing about herbs, this author cannot refer to herbs as "medicines" or "treatments," no matter how effective these substances may seem. You may also notice a careful choice of words in the written information about herbs and supplements.

                         

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​​​​Any questions, comments, suggestions, recommended additions or corrections will be very welcome. I will review add, subtract, and amend information as needed. Greatly appreciated!

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