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HERBAL AND NATURAL REMEDIES |
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Fast Facts
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There are no herbal medicines whose health claims are based on the
quality of evidence required by the FDA for regulated medicines.
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The
contents of many herbal products don't match the ingredients listed
on their labels.
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In addition to their direct toxicity, herbal
medicines may also cause dangerous problems by interacting with
conventional drugs and reinforcing or antagonizing their actions.
Description
Herbal medicines are extracts of plants that have been used
as medicines for thousands of years. Other natural remedies include minerals
such as iron and calcium, and materials obtained from animal sources,
such as glucosamine and chondroitin sulfate.
What's the difference?
All medicines, natural or conventional, work by altering
some aspect of body function, such as lowering blood pressure or blood
sugar. The active ingredients of natural remedies are chemicals that are
very similar to prescription and over-the-counter (OTC) medications. Therefore,
they have the same potential to cause beneficial and harmful effects.
Although natural and conventional medicines work in similar ways, there
are important differences between them.
1. Regulation
Prescription and OTC medications are regulated
by the Food and Drug Administration (FDA), an agency of the United States
government. Before prescription drugs are made available to the public,
they must be tested to assure that they are safe and that they work. Herbal
and natural remedies are essentially unregulated and do not go through
this screening process.
2. What's in the bottle?
Regulated prescription and OTC medications drugs are purified
compounds. This means they are tested to determine a safe dose, and each
dose must be consistent in composition and activity. For example, each
time you take an aspirin, the same amount of medicine is delivered to
your body.
In contrast, herbal extracts may contain hundreds of chemicals, each
of which can affect your body. Analyses by government and consumer organizations
reveal that the contents of many herbal products do not match the ingredients
listed on the labels. Therefore, one bottle of an herbal remedy can contain
vastly different ingredients from the next bottle.
3. What else is in the bottle?
Herbal medicines can contain dangerous contaminants, including pesticides,
lead or mercury. More disturbing is the inclusion of prescription or OTC
drugs in some “natural” herbal preparations. Studies have shown that herbal
products can contain cortisone-like hormones, diuretics, Viagra, aspirin
and/or tranquilizers. A number of “natural herbal” remedies for arthritis
have been found to contain conventional arthritis medications such as
indocin and prednisone.
4. Are herbal medicines safe?
We simply don't know. Manufacturers are not required to perform safety
studies before selling herbal or other natural products, nor are they
required to maintain records of adverse events or to report them to the
FDA. Many people incorrectly assume that remedies used for centuries must
be safe. Unfortunately, we have learned in recent years that many traditional
herbals have dangerous, and even fatal, side effects.
For instance, herbal medicines called birthwort or snakewort, made from
extracts of Aristolochia plants, have been used all over the
world for more than 1,000 years. We now know that these plants contain
aristolochic acids, substances that can cause kidney failure and cancer
of the kidney. Yet, herbal remedies that contain aristolochic acids can
still be purchased in retail stores or on the Internet.
5. Do natural products work?
To gain approval from the FDA, claims for health benefits of conventional
drugs must be supported by scientific data. These regulations do not apply
to herbal medicines or other dietary supplements. The health benefits
claimed for these products are based on tradition and little or no data.
There are no herbal medicines whose health claims are based on the quality
of evidence required by the FDA for regulated medicines.
Herbal remedies for arthritis
Herbal remedies promoted for the treatment of arthritis include, ginger,
Chinese Thunder God Vine, willow bark extract, feverfew, cat's claw and
stinging nettle.
While there is some evidence that ginger and willow bark extract may
relieve pain, these remedies contain chemicals that are similar to conventional
nonsteroidal anti-inflammatory compounds (NSAIDs) like naproxen (Aleve)
and ibuprofen (Advil). NSAIDs may cause inflammation of the stomach and
intestines. Further, they can interfere with blood clotting and lead to
fluid retention, causing problems for people with high blood pressure
or heart failure.
Chinese Thunder God Vine also relieves pain and inflammation, but chronic
use may cause weakening of the immune system and bones (osteoporosis).
Supplements for arthritis
Supplements are also marketed over the counter to address rheumatologic
symptoms. Again, however, patients would be well advised to consider the
realities.
S-adenosylmethionine (SAMe), a naturally occurring chemical in the body,
has been used in Europe for some time as a prescription drug for depression
as well as a relief of arthritis pain and inflammation. While the role
of its anti-depressant action in providing subjective relief from arthritis
is unclear, there are other deterrents. SAMe is not efficiently absorbed
into the body when taken by mouth nor are there any large, well-controlled
studies of its effectiveness. Further, this very expensive supplement
can cause gastrointestinal distress as well as reported incidents of extreme
agitation. Like other unregulated products, many commercial preparations
of SAMe do not contain the quantity of drug indicated on the label.
Chondroitin sulfate and glucosamine supplements are promoted separately, or in combination, for patients with degenerative arthritis (osteoarthritis). Some studies suggest that these products can relieve arthritis pain but other studies found no benefit. A recent trial that was supported by the National Institutes of Health found no clear evidence for relief of pain.
As for the combination approach, no evidence supports chondroitin plus
glucosamine as being more effective than glucosamine taken alone, and
product analyses by a consumer organization found more variability in
chondroitin than in glucosamine preparations.
That said, these products appear to be relatively safe, and may be worth
considering for people who have severe pain despite conventional treatments.
Fish oils that contain omega-3 fatty acids have been reported to relieve
pain and joint tenderness in patients with rheumatoid arthritis. The benefits
are modest and may take several months to appear. Side effects include
gastrointestinal distress and a fishy odor to the breath. Those who consider
fish oil should remember some fish oil supplements may contain high levels
of mercury or vitamin A.
Points to Remember
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There is no scientific basis for advertised claims that
natural remedies are as effective as conventional medicines and
safer.
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The effects of natural remedies on the body are
similar to those of conventional medications.
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Because
the FDA has little oversight of natural products, they are
poorly standardized and may contain undisclosed prescription medications,
and can cause serious side effects.
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In view of
the lack of information about quality control, safety
and effectiveness, the use of herbal remedies is not recommended.
To Find a Rheumatologist
For a listing of rheumatologists in your area, click
here.
Learn more about rheumatologists and rheumatology
health professionals.
For more information
Many books, magazines and web sites provide advice about using herbal medicines
and other dietary supplements. These sources promote the use of these remedies
in an uncritical manner and they do not provide adequate information about
potential dangers. The most reliable and accessible information is provided
though health newsletters published by nonprofit consumer organizations and
medical schools. Sources of more technical information are listed below.
The American College of Rheumatology has compiled this list to give you a
starting point for your own additional research. The ACR does not endorse or
maintain these Web sites, and is not responsible for any information or claims
provided on them. It is always best to talk with your rheumatologist for more
information and before making any decisions about your care.
U.S. Food and Drug Administration, Center for Food Safety and Nutrition
http://www.cfsan.fda.gov/~dms.supplmnt.html
Office of Dietary Supplements of the National Institutes of Health
http://ods.nih.gov/index.aspx
The Agency for Healthcare Research and Quality
http://www.ahrq.gov
National Center for Complementary and Alternative Medicine
http://nccam.gov/health/supplements.htm
Written March 2005
Written by Donald Marcus, MD, and reviewed by the American College of
Rhematology.
