Buyer'sGuideforHerbs

Not so long ago, people bought herbal remedies in quaint little shops that sold "natural foods." They scooped them out of bins, poured them into plastic bags, and took them home to brew into teas and other potions. Today, you can get herbal remedies at drugstores, supermarkets, and health-food superstores, or order them from catalogs and via the Internet. However you harvest your herbs, you now face more choices -- and wilder health claims -- than ever before.

"For the average person, walking into a store that sells herbal products is like entering a jungle," says James A. Duke, Ph.D., an expert on herbs and former chief of the U.S. Department of Agriculture's Medicinal Plant Laboratory. Without reliable information, the dozens of brands and hundreds of herbs found in stores can add up to a confusing jumble. With that in mind, here's what you need to know to make smart choices about herbal remedies.

What Is an Herbal Medicine?
Traditionally, botanists define an herb as any plant that dies down to the ground each winter. But many experts prefer a broader definition and consider herbs to be any medicinal plants. Also called botanicals or phytomedicines, these plants include spices, as well as products made from tree bark, flowers, stems, roots, and leaves.

Some herbs, such as ginkgo and ginseng, have been used for thousands of years in Asian cultures, while others, including echinacea, have been mainstays of Native American medicine for centuries. And, although herbal remedies may seem exotic to Americans who are used to pharmaceutical drugs, they were widely used in this country until the 1950s, when single-chemical compounds manufactured by pharmaceutical companies began to replace them. Even today, one out of four of all conventional pharmaceutical drugs contain at least one plant-derived ingredient, according to Mark Blumenthal, executive director of the American Botanical Council, a nonprofit research and educational organization based in Austin, Texas.

In the last few years, herbs have made a comeback. At least 60 million Americans spend a collective $3.2 billion on herbal products annually, and the market is growing by 25 to 30 percent each year, notes Blumenthal. Why the renewed interest? Experts propose several reasons, among them a growing skepticism of the medical establishment, a search for lower-cost alternatives to prescription drugs, and increasing involvement by consumers in their own health care.

The National Institutes of Health (NIH) is funding research projects and clinical trials at medical institutions around the country on St. John's wort, ginkgo biloba, and garlic. Other NIH-funded studies focus on various Chinese herbs that seem to have anti-inflammatory and pain-relief properties, as well as on herbs that may boost the immune system.

Still, herbal research in the U.S. is in its infancy. Most of our information about the effectiveness and safety of popular herbs comes from studies carried out in Europe. Germany is in the forefront of this research. Scientists there have conducted rigorous studies on botanicals such as St. John's wort (to treat depression), saw palmetto (for common prostate problems), echinacea (to stimulate the immune system), ginkgo biloba (to treat memory loss and alleviate symptoms of Alzheimer's disease), milk thistle (to protect the liver against toxins), and feverfew (to prevent migraines). Approximately 80 percent of Germany's physicians prescribe herbal products, according to Blumenthal.

It seems unlikely that herbs will ever be studied as fully in the U.S. Typically, it takes 10 to 15 years and approximately $500 million for a manufacturer to get the Food and Drug Administration's (FDA) approval for any new drug. Since herbs cannot be patented, pharmaceutical companies will not spend that kind of time or money trying to win approval for a product that anyone can manufacture and sell.

And yet, the money that Americans spend on herbs every year speaks for itself. "The potential for the use of herbal remedies in this country is great, and traditional physicians need to become more educated about them," observes Steven Lamm, M.D., an internist affiliated with New York University School of Medicine and coauthor of Younger at Last (Pocket Books). "It would be a mistake to ignore a host of agents that can be helpful to people."

Are You Getting What You Pay For?
When James Duke says that walking into a store that sells herbal supplements is akin to entering a jungle, he's not exaggerating. The FDA has little authority over herbal products in this country. That means the agency does not inspect factories, either in the U.S. or abroad, to make sure they meet the same safety and cleanliness standards required of manufacturers of prescription or over-the-counter drugs. Nor does it check products to determine whether they contain what they claim or to make sure that they are free of contaminants or dangerous additives. "As a result, the buyer does not necessarily know whether an herbal product is uncontaminated, safe, and effective-or even whether the capsule, tablet, or tea bag contains any of the particular herb," notes Duke.

Currently, the FDA treats herbal remedies as "dietary supplements." Labels on herbal products cannot claim to cure or prevent a disease, but they can state how the product affects the body's "structure or function." For example, the manufacturer of a saw palmetto product cannot claim that the herb reduces an enlarged prostate. But it can say that the product may improve urinary flow in older men. Even this type of statement must be accompanied by a disclaimer noting that the health claims have not been reviewed or approved by the FDA.

The American Botanical Council and other organizations would like to see this country establish an herbal standards board similar to Germany's Commission E, which acts as an adviser to the German equivalent of the U.S. FDA. "Commission E sets the standards for approval of all herbs sold in German pharmacies," says Blumenthal. It also publishes monographs about herbal products that list the scientific data, dosage recommendations, side effects, and contraindications (circumstances in which the drug shouldn't be used). With each purchase of an herbal medicine, the consumer receives one of these monographs as a package insert. Commission E also requires that manufacturers regularly provide quality-control testing and manufacturing data.

Before You Buy
With few restrictions on herbal manufacturers, is it possible for the average consumer to buy safe, effective herbal products? Yes, says Duke, but only after doing some research. "Don't rely on pamphlets published and distributed by health-food stores or herbal-product manufacturers," he advises. "Use books to educate yourself about particular herbs." The following books provide the best available information on a variety of herbs: Popular Herbs in the U.S. Market: Therapeutic Monographs, by Mark Blumenthal and Chance Riggins (American Botanical Council, $15; to order, call 800-373-7105); The Green Pharmacy, by James Duke (St. Martin's Press, $6.99); The Complete Medicinal Herbal, by Penelope Ody (Dorling Kindersley, $29.95); and Tyler's Honest Herbal, by Varro E. Tyler and Steven Foster (Haworth Press, $24.95).

Here are some other tips to keep in mind:

Before trying an herb, be sure your medical condition has been diagnosed correctly. Tell your doctor about any herbal remedies you plan to try or already take. "For example, some herbs like garlic, ginger, and ginkgo biloba can thin the blood," says Duke, which may increase the effects of anticoagulant prescription drugs such as warfarin, and thus cause problems. Choose herbal products manufactured by companies that have been in business for a long time and have recognizable names. Another clue of reliability is a manufacturer's address and an 800 number on the label. "You should be able to call with questions about the product," says Duke. After You Buy
Watch for allergic reactions or side effects. By and large, herbs are safer and have fewer side effects than many prescription drugs because they're milder and more dilute. But some people will exhibit allergic reactions or sensitivities to specific foods, herbs, or drugs. For example, ginseng can cause restlessness and irritability in a few very sensitive people. And a handful of individuals who are allergic to ragweed and plants in the daisy and aster families will also find that they are allergic to chamomile products.

Allergic reactions to herbs may be mild, including a skin rash, a stuffy or runny nose, itchy eyes, dizziness, an upset stomach, or diarrhea. In rare instances, an herbal remedy may cause a serious reaction called anaphylactic shock, a condition that can also be triggered by foods, drugs, or insect stings, and that always requires immediate emergency medical attention. Symptoms of anaphylaxis include difficulty breathing, rapid pulse, cold sweats, nausea, abdominal cramps, swelling of the tongue or throat, and itchy, raised hives.

Because of the slight chance that herbs can trigger allergic reactions or side effects, Duke recommends that you "always start with the smallest dose possible. For example, take 30 or 60 milligrams (mg) of ginkgo biloba to begin with, rather than 120 or 240 mg." Also keep in mind that an allergic reaction does not strike the first time you're exposed to any offending substance. Instead, it occurs after the second or third exposure, so increase the dose of any herb only gradually.

If you want further guidance, consider consulting a naturopathic doctor (ND) who has graduated from one of the three accredited colleges of naturopathy in this country: Bastyr University in Seattle; National College of Naturopathic Medicine in Portland, Ore.; and Southwest School of Naturopathic Medicine in Phoenix.

Blumenthal hopes that herbs will become a part of conventional medicine. "For too many years, herbs have been marginalized or discounted as 'alternative' or unconventional medicine," he concludes. "One day we may see a 'return to the future' as herbs become fully part of mainstream medicine in this country."