Are Herbal Supplements Safe? -- Arthur Presser, PharmD, DHPH

WebMD Live Events Transcript
Event Date: Wednesday, June 2, 2004

By Arthur Presser, PharmD, DHPh
WebMD Weight Loss Clinic

Millions of people take herbal supplements because they want to ingest something safe and healthy. But just because something is natural, is it safer than a synthetic drug? And exactly who is looking over the manufacturers' shoulders on your behalf? Supplement expert Arthur Presser, PharmD, DHPh, joined us on June 2, 2004, with some answers.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Presser. How are herbal supplements regulated in the U.S.? Are they given the same level of scrutiny as prescription drugs?

PRESSER:
No, of course not. Prescription drugs have the highest level of scrutiny because they're literally chemical poisons that we're using for their positive benefits against their negative benefits. They're used to treat diseases and conditions that must be diagnosed and monitored by physicians. The next level down would be over-the-counter drugs that are on the market for conditions that are self-diagnosable and self-limiting.

Herbs are considered dietary supplements, and basically part of the food chain. Prescription drugs, to come to market, must undergo hundreds of millions of dollars of clinical testing to prove their efficacy and measure their toxicity. Herbs are nature's medicines that have sometimes 5,000 years of historical use for many conditions. Only in recent times have universities and private industry taken these traditional uses and run clinical studies to determine how they might be working or have worked in the past and predict what they might be useful for in the future. However, they are still dietary supplements, and really are subject to claims that are just associated with structure and function of the human body.

You have to understand that there is a very strong political aspect to herbal medicine. Between 25% and 50% of pharmaceutical drugs on the market today are derived directly from, or from a model of, a plant chemical. This plant chemical cannot be used directly as it comes from nature because it cannot be patented and protected financially, so the chemical must be altered into a new entity, an analog, and then tested for efficacy and toxicity. If this new chemical works and isn't too poisonous, it is entered into the hundreds of millions of dollars of testing to bring a new drug to market.

The herbs in themselves, as whole herbs, are generally much milder, generally not toxic, take longer to work, and are much more complicated than pharmaceutical drugs. Pharmaceuticals are monostructures; that is they contain one single chemical. Herbs can contain hundreds and hundreds of chemicals, each doing something different in the bodies, oftentimes offsetting toxicities; that is if there is a chemical that might raise blood pressure there may be a secondary chemical that offsets chemical A's ability to act in this manner.

In terms of manufacturing, many medicinal herbs today are manufactured by pharmaceutically licensed laboratories. All herbs and dietary supplements must comply with government GMPs -- good manufacturing procedures. This is not to say that some companies don't use inferior ingredients.

MEMBER QUESTION:
But some herbals are more potent than some prescription drugs, aren't they? They are more likely to cause problems if taken incorrectly, I guess I should say.

PRESSER:
I can't think of an herbal medicine that is stronger and more toxic than an equivalent pharmaceutical drug, unless you are considering strychnine or arsenic, which do occur in nature naturally. Certainly there are things like poison mushrooms, but I don't consider those medicinal. I'm working in the world of herbs that heal and herbs that are beneficial, not things that are poisonous.

MEMBER QUESTION:
How do we know that what is on the label is what is in the bottle with herbs? I've read that bottles of the same herb from different manufacturers can vary a lot. Why can't they ensure that the herbal supplements are pure and actually the strength claimed?

PRESSER:
This aspect of commercially available herbal preparations is not well regulated. You can pick up two bottles of St. John's Wort, and unless you are buying from a reputable manufacturer you can be getting two completely different medicines. This is the greatest problem that faces complementary medicine today. As a health care professional, if I were to advise a patient with mild to moderate depression to take St. John's Wort, unless I named a specific brand, I would not be sure they were getting a good medicine.

For those who are interested in using medicinal herbs you must seek out reliable retail establishments that staff trained personnel who, hopefully, know which the best, reputable brands are.

MEMBER QUESTION:
Is there any comprehensive source of information on supplement/drug interactions?

PRESSER:
Yes. There are several good sources for drug interactions Some of them are extensive books. Some of the books that I use are:

  • A to Z Guide to Drug/Herb Vitamin Interactions
  • PDR for Herbal Medicine
  • Herbal Medicine Expanded Commission E Monographs
  • American Herbal Products Associations Botanical Safety Handbook
Other sources might be online through the American Botanical Council or the American Herbalist Guild.

MODERATOR:
Is it important to let your doctor know about all of the supplements you are using before they prescribe any medications?

PRESSER:
In terms of safety, it is critical that if one is taking or being prescribed pharmaceutical medicines, that one informs the prescribing physician of what you're taking. There are legitimate herb/drug and dietary nutritional supplements interactions. Unfortunately, today it is probably next to impossible to find a physician or pharmacist who is well versed enough in this area to identify such an interaction readily.

This is one of the things that I am working hard to do, traveling, giving lectures to pharmacy associations, continuing education classes, and working through a distance learning university called The American Academy of Nutrition to prepare educational materials for retailers, pharmacists, nurses, MDs, etc. It's almost mandatory to either have your doctor seek advice and research (which is unlikely; he or she will probably say don't take the herb), or research it on your own, or go to an herbalist to research the safety.

Many times taking an herb with prescription medicine enhances activity. I encourage people who take antibiotics to take eluthero, because the eluthero enhances the bacteria-killing ability of the drug. I encourage people who are undergoing cancer therapies to use host-building herbs.

MEMBER QUESTION:
What kind of health care giver should you see if you want to take herbal medicines? I am not comfortable picking out herbs from the shelf for myself.

PRESSER:
Many times better vitamin stores employ trained personnel. Otherwise, one might seek the advice of a physician who utilizes or integrates natural medicines into his or her practice. In many states, naturopaths are recognized and licensed health care professionals. Internet searches of complementary and alternative medicine organizations may help lead you to a practitioner in your zip code. I would begin with the American Herbalists Guild and perhaps the American Botanical Council.

MEMBER QUESTION:
What herbs are safe to take for weight loss?

PRESSER:
Weight loss is a complicated area. Obesity is an epidemic in the United States today. In the last decade, obesity for adults in their 40s went up 34% and up 48% for people in their 50s. We're learning today that obesity can be directly related to many diseases, not just cardiovascular, which would include coronary artery disease, high blood pressure, hypertension, but also diseases like cancers. Fat cells can make estrogen. Estrogen can drive breast cancer. So I take obesity very seriously.

If one is young their bodies can sustain things that people over 40 might need to be careful for. There are weight loss supplements on the market that contain stimulants. A young healthy person would not think twice about consuming five or six cups of coffee per day and probably would not have to think twice about consuming weight loss products that contain stimulants. These stimulants are often thermogenic agents. Thermogenic agents are ingredients or chemicals that contain natural chemicals that stimulate certain fat cells in the body to turn up their thermostat and generate more heat at the expense of fatty acid fuel.

Now, this is not the final answer. This mechanism makes a small contribution to overall weight loss. Weight loss is still governed by what goes in your mouth and how much you move your body. But every little bit helps.

On the other hand, what about those of us that are in our 40s and 50s and 60s who have put on the middle-age spread who are now at an age when our doctors have informed us that we are borderline hypertensive or perhaps hypertensive enough to be on medication, our blood sugar may be riding high in a prediabetic state, and we're advised to stay away from stimulants. Up until very recently there were not many supplements available to this age group. Things that were available and still are available are things such as calorie blockers and supplements that contain fiber, which tend to fill the stomach when consumed with large quantities of water.

There has been a product on the horizon for several years that I have been following the ingredients of, not for weight loss, but in antiaging research. One such ingredient is a proprietary extract from a plant called cat's claw. Indigenous people use cat's claw for inflammation, tumors, and rheumatism, and laboratory tests show that ingredients in this plant increase immunity reduce inflammation and are potent antioxidants. A manufacturer wanted to combine this novel extract with medicinal mushrooms, which also have activity on immune response and overall health. Being a pharmaceutical lab, they realized when combining ingredients you can't say the whole is equal to the parts unless you retest. When they retested the new combination they discovered that all the indices of aging they tested for improved:

  • Decreased DNA damage
  • Increased DNA repair
  • Decreased inflammation
  • Increased antioxidant activity
  • Increased immune response
  • Increased apoptosis (that means programmed cell death or cells the body needs to rid itself of)
  • 78% of the test population lost up to 7 pounds in four weeks.

Because as a dietary supplement you cannot make claims for inflammation, cancer, and the like, this company decided to market this product as a 40-plus dietary supplement that has the ability to improve metabolism. I have been taking these ingredients separately for the last five years; today they're available in one pill, with new other novel ingredients for weight loss, and marketed under the name Xenadrine 40 Plus. So now those of us over 40 who may have health challenges can use a product with no known side effects or drug interactions, that can help with metabolism, aches and pains, fatigue, and enhance DNA repair. Xenadrene 40 Plus is very readily available in the mass market across the country.

MEMBER QUESTION:
What herbs would you recommend for anyone over 40?

PRESSER:
I would recommend Xenadrene 40 plus and an herb that, until recently, has been virtually unknown in the U.S., called rhodiola. It comes to us from behind the iron curtain. Today Russia is more forthcoming with many of their secrets, probably for commercial purposes. Rhodiola is indigenous to Eastern Siberia and grows in altitudes of up to 18,000 feet. Legend has it that rhodiola has been passed from generation to generation for about 3,000 years. It's said that people who drink rhodiola tea will live to be more than 100 years old. Interestingly enough, the famous people of the Georgian area of Russia use rhodiola commonly and do live to be more than 100 years old. They use it to increase physical endurance, fight fatigue, and even depression.

This is an herb that is now being clinically tested around the world and being found to put its money where its mouth is. The Russians have done research on it themselves and find it to help protect the cardiovascular system, to have antitumor activity, to help control blood sugar, to increase general immunity, and many more benefits.

I like to recommend this herb for general stress. It's like ginseng in that it acts as an adaptogen. Adaptogens help the body cope with stress as a general tonic. It is available under many labels today. I would look for one that was standardized for rosavin and secondarily for salidroside. This will ensure that you are getting a good extract. Two brands that come to mind are Herb Fighter Select and a product called Rhodax by Pinnalce/Bodionics. Those are two companies that use good raw material and are both available via an online search.

I personally came across this herb before it was commercially available on the market. I was researching herbs that helped reduced altitude sickness. I was planning a high-altitude mountain climb in the Andes. I found rhodiola mentioned in studies and worked my way to a Russian biochemist named Zakir Ramazanov. He was kind enough to send me a plastic bag full of powder. I then became the pharmacist I was trained to be and punched my own capsules. I found that after using the herb for a short period of time my recovery after prolonged workouts shortened and my performance during exercise increased. Today rhodiola is available widely.

MODERATOR:
Dr. Presser, we are almost out of time. Do you have any final words for us?

PRESSER:
Time flies when you're having fun. I love to talk about herbs and can do it all day and all night. I promise to come back and talk another day. In the meantime, my take-home message is that herbs are good for you, but they are not warm fuzzies. We need to treat them with respect, know what we're doing, not work in a vacuum, and not rely on them as a substitute for professional medical advice when indicated.

You can reach me through the American Academy of Nutrition (aan.edu). At the site you can write your question and put down that you want to reach Dr. Presser. I will get back to you as soon as possible.

MODERATOR:
Thanks to Arthur Presser, PharmD, DHPh, for sharing his expertise with us. For more information, please read his book, Pharmacist's Guide to Medicinal Herbs.


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