Ensuring Safety and Quality in Supplements and Herbal Medicine
Posted Oct 17 2008 9:14pm
A lot of people are interested in herbal medicine but have been scared off by reports of contamination and other quality problems with Chinese herbs. Others spend their money on American-made dietary supplements based on the advertising hype, without knowing if they are getting what they are paying for. Generally speaking, American supplements come under fairly stringent manufacturing requirements – at the least, they shouldn’t have any more rat parts than your hot dogs do. A bigger concern is if they contain what you are led to believe.
Quality and safety are two interconnected but different issues. You can have a great herbal formula, made of the best components and completely free of contaminants; if it is inappropriate for your condition or your constitution, it is still not safe. Here are some tips for finding quality products, and information on some safety issues you may not have considered.
Let’s start with a look at the label. The ingredients list should be very specific. Look for details like these:
For herbs, the specific species and part of the plant used should be listed. For example the term “Valerian Extract” does not tell you much, but if it also says “Valeriana officinalis (root)” then you’ve got a good idea of what you’re buying. If you get the wrong species or wrong part of the plant, you’re just buying the waste products that better manufacturers wouldn’t touch.
For supplements, the specific chemical compound should be listed - such as ascorbyl palmitate (Vitamin C) or d-alpha tocopherol succinate (Vitamin E). Not all forms of a nutrient are equally effective. An important issue is bioavailability - how well that nutrient can be absorbed and used by the body.
The amount of each ingredient should be listed separately. A “proprietary blend” of several ingredients means you have no idea if you are buying 1 mg or 500 mg of any particular ingredient. Chances are, you’re mostly getting the cheapest items in the list.
Anything manufactured outside of the U.S. should be GMP (Good Manufacturing Practices) certified.
Any fillers and/or preservatives should be listed. Better yet would be a statement that no preservatives and/or fillers have been used. This can be very important if you have allergies to corn, gluten, etc. It is possible to buy supplements without any fillers or coatings, binders, shellacs, artificial colors, fragrance, excipients, wheat, yeast, gluten, corn, sugar, starch, preservatives or hydrogentated oil.
If you are a strict vegan, make sure any capsules used are not from animal sources such as gelatin.
You should also be able to get some information on quality testing - perhaps on the manufacturer’s web site. The best manufacturers test every lot of their finished products (preferably using independent assays). A big problem with supplements, including herbs, is that the finished products simply don’t contain the amounts and proportions of ingredients that they should.
For Chinese herbs, the new Chinese Good Manufacturing Practices (GMP) standard is pretty good. The Australian Therapeutic Goods Administration (TGA) certification is considered one of the most stringent in the world: their guidelines for dietary and herbal supplements are the same as for their pharmaceuticals.
Many of the scare stories in the press are about heavy metals and/or pharmaceuticals being found in herbal supplements. Some heavy metals are picked up from the soil, and some were purposely used in traditional formulas. In China, combining herbs and pharmaceuticals is not necessarily illegal, but those products should certainly not be entering the U.S. as dietary supplements. Sticking with a top quality manufacturer will let you rest easy about these issues.
Note that GMP certification relates to manufacturing standards rather than ingredients. With herbs, proper identification of raw materials is critical. Testing of plant constituents is important, as these vary depending where and how the plants are grown, harvested, etc. Good companies use chemical analyses including TLC (thin layer chromatography) and HPLC (high performance liquid chromatography) to confirm identification, ensure potency and test for levels of active constituents.
If the product is well made, is it safe for me? Chinese herbal medicine constitutes a highly complex approach to herbal treatments. Most of the formulas contain numerous herbs, and are meant to treat a specific pattern of disease symptoms. It takes years of study to get a good grasp of Traditional Chinese Medicine (TCM) diagnostics, individual herb properties, dosages, cautions and formulation theory. If you are picking formulas for yourself off the shelf or from a web site, understand that you are taking responsibility for diagnosing and treating yourself using principles and medications that you probably don’t understand very well. In TCM, diseases are sub-divided into specific “patterns” which indicate the nature of the disease and imply root causes which can be very different from one another. There might be half a dozen different treatments for a general condition like stomachache, or headache. Without understanding the properties of the formula you are taking, you can easily make yourself worse because it is inappropriate for your specific condition.
Another key point: “natural” does not automatically mean “safe” (think of hemlock, lead, arsenic, etc.) TCM medicinals include a number of potent substances that most definitely are not safe when used inappropriately. A good example is the misuse of ephedra (da huang) as a weight-loss aid. In TCM, its primary application is for certain respiratory problems, and it is noted to be unsafe for those with heart problems and other conditions. It’s a useful herb when properly used. It can be deadly when abused.
The dietary supplement industry is big business, and products can be rushed out with the flimsiest of evidence that they are beneficial. Consumers are the primary testers for side-effects. And yes, herbs - like any other substance that changes the way your body functions - can have side effects.
Herb-Drug Interactions Another area of concern is adverse drug-herb interactions. Fortunately these appear to be few, but the possibility needs to be considered. St. Johns Wort, for example, has been found to interfere with several classes of drugs. In theory, anything you ingest has the potential to interfere with the metabolism of anything else you ingest. Always follow instructions on how and when to take supplements and herbal medicines, as well as pharmaceuticals.
A more common problem is duplicating the actions of a pharmaceutical prescription with an herbal formula or supplement. For example, many herbs, supplements (and over the counter drugs) can affect the blood-thinning actions of warfarin (coumadin).
This is a rapidly growing area of study. Books on the subject are likely to be dated. Read the package inserts for any pharmaceuticals you take. You can also check the Healthnotes resource, which is licensed to numerous online companies and in-store kiosks. One publicly available access point is at the Pure Encapsulations web site, in their Health Library section: www.purecaps.com/ClinicalEssentials_index.asp
Some General Precautions It is probably safest to avoid mega-doses of anything. Recent studies suggest that people taking large doses of vitamins, for example, are not as healthy as those taking moderate amounts. Herbal medications as just that - formulas used to treat medical conditions. Most are not meant to be taken indefinitely for general health purposes (look to diet and exercise for that). On the other hand, most of us could probably benefit from a good quality, well-balanced vitamin and mineral supplement, and a little daily fish oil. Here are a few suggestions to keep in mind when considering supplements and herbals.
Ask an expert. Go to someone with a few years of formal education and a state or nationally recognized certification in their field (such as nutrition or Chinese herbal medicine). Even then, realize that people who are not trained as medical doctors may miss some “red flag” symptoms that suggest serious disease. If you have an ongoing medical problem that is not being resolved by “alternative” treatments, it’s worth getting a checkup from your doctor. Even if you choose alternative treatments, a biomedical diagnosis can be a powerful piece of information to inform your choices.
Avoid vendors making unlikely claims and/or operating highly profitable marketing structures. Check www.scholar.google.com to see if you can find any serious research on the product in question.
Avoid mega-doses of anything, unless there are a couple of decades of experience with those levels of dosing. Avoid harsh and extreme forms of treatment.
Pay attention to how your body responds. Just because you know someone who did well on a particular product doesn’t mean that you will. Maybe that ill feeling really does mean you getting worse, and not a “healing crisis.”
Avoid dieting products, unless they are very well grounded in a strong nutritional approach. Any product that promises fast results with no effort or changes on your part should be viewed with a great deal of caution and skepticism.
Don’t expect a pill (or a handful of them) to make up for poor diet, inadequate exercise and other damaging lifestyle choices.
In the end, you shouldn’t be afraid to access the benefits available to you from dietary supplements and herbals. There are a lot of great products available to enhance the nutrition you get from your food, and some excellent alternatives to pharmaceutical therapies for illness. Armed with the tips from this article, you will be better prepared to make good choices.