“All Natural”: This label appears on a growing number of nutraceuticals, cosmetics, cleaning products, and over-the-counter medicines. This is, in part, why herbal medicine is so popular. But does “natural” always mean that something is safe?
Herbal medicine involves using plants for therapeutic purposes. Characteristically, they are taken orally or applied to the skin; these herbal remedies can come in a variety of forms, such as salves, oils, capsules, pills, and herbal teas.
Although many people use them as medicine, herbal supplements are not regulated by the FDA in the same way that prescription and over-the-counter drugs are. Because of this, some potentially dangerous herbal remedies can be found in stores, online, and even at local coffee shops. Consuming them is done at your own risk. Before taking any herbal remedy, be sure to research it and consult with your healthcare professionals—doctors, pharmacists, and anyone else involved in your medical care.
Risky Herbs
“Some people believe that herbal supplements really work, but they’re harmless”; however, if a substance acts like a drug inside the body, it can also have negative effects, according to Dr Adriane Fugh-Berman, an expert on herbs and dietary supplements, and an instructor at Georgetown University School of Medicine.
“Most of the herbal remedies we use in the United States are relatively harmless,” Fugh-Berman says; “however, some are dangerous on their own, while others are dangerous if taken incorrectly.”
Any substance that acts like a drug has certain risks, warns Dr Cydney McQueen, a pharmacist and professor at the University of Missouri-Kansas City School of Pharmacy.
In the case of herbs that pose significant risks, the greatest common risks are liver and kidney damage, as well as interactions with other medications. The following are examples of herbs with risks you may not be aware of. This is not an exhaustive list of all herbs or other supplements that can be dangerous; it serves only to illustrate that some high-risk ingredients are readily available to anyone through over-the-counter sales. Therefore, we repeat: be sure to consult your healthcare professionals before taking any herbal remedy.
St. John’s Wort
St. John’s wort (*Hypericum perforatum*) may help relieve mild to moderate depression, according to Dr Andrew Weil, founder and director of the Arizona Centre for Integrative Medicine at the University of Arizona. However, there is not enough evidence to suggest that it is useful for treating major depression.
Additionally, depression is not a condition that should be treated without professional help. “It’s not the common cold. If somebody wants to use St. John’s wort to treat depression, they should remain under the supervision of a healthcare professional,” McQueen tells WebMD.
Here’s one main reason why: drug interactions. St. John’s wort can decrease the efficiency of many other medications. There have been documented cases involving unintended pregnancies in females taking St. John’s wort and birth control pills at the same time, as well as cases of organ rejection in patients taking St. John’s wort with immunosuppressant drugs after a transplant.
“If you are taking any prescription medications and are interested in trying a St. John’s wort regimen for mild to moderate depression, consult your doctor or pharmacist first about potential interactions,” advises Weil, whose line of dietary supplements comprises a product containing St. John’s wort.
Kava
Kava (*Piper methysticum*) may reduce anxiety and, in some cases, is as effective as prescription anti-anxiety medications. However, its effects can take up to eight weeks to appear. In the case of women experiencing anxiety during menopause, kava has shown results in as little as one week, according to the National Institutes of Health (NIH).
Still, the National Institutes of Health and the FDA urge the public to avoid consuming kava due to the risk of serious illness, liver damage, and even death, even when taken for a short period of time and at typical doses. Kava consumption has led to cases requiring liver transplants and resulting in death within one to three months. “Excessive kava consumption has been associated with neurological damage and skin abnormalities,” Weil tells WebMD.
Kava may worsen depression and is not safe for pregnant or breastfeeding women. Because this herb has effects similar to alcohol, the two should not be taken together.
Several prescription medications should not be taken with kava. The two medications that show the highest potential for drug interactions are alprazolam (Xanax) and tranquillisers. Weil recommends kava only for a maximum of three to four weeks in patients with healthy livers. “I do not recommend kava for people who are at risk for—or already have—liver disease, who regularly drink alcohol, or who are taking medications with known adverse effects on the liver, with statins and acetaminophen.”
Other experts have strongly discouraged the use of kava. “I prefer to use herbs that offer a favourable risk-benefit ratio, and in the case of kava, that is no longer the case,” Fugh-Berman says.
Comfrey
Comfrey (*Symphytum officinale*) has a “well-deserved standing for its ability to heal injured tissues”—such as wounds, bruises, sprains, and broken bones—as well as the swelling and inflammation that can accompany it, Weil tells WebMD. However, because of the risk of causing serious liver damage—and possibly lung damage—”comfrey should not be ingested,” Weil warns.
In 2001, the FDA recommended that manufacturers voluntarily recall products containing comfrey. Despite this, comfrey remains easy to find.
“Our neighbourhood coffee shop serves comfrey tea; when I mentioned to them that it’s a liver-toxic herb, they said, ‘Oh, well, we buy a lot of it,'” Fugh-Berman recounts.
Weil recommends applying comfrey to wounds that are slow to heal, including open pressure ulcers and diabetic ulcers. However, the United States Pharmacopoeia—a scientific organisation responsible for setting standards for dietary supplements—advises against using comfrey on open wounds, as toxins that can affect the liver can be absorbed through the skin.
Chaparral
Chaparral (*Larrea divaricata*, *Larrea tridentata*) is touted for its ability to relieve pain, inflammation, and itching of the skin. However, as Weil tells WebMD, there is little evidence to support these claims. Additionally, chaparral is touted as an herb with anticancer properties; however, the American Cancer Society reports that there is no evidence to support this claim. Chaparral—which is readily available online in various forms—has been listed on the FDA’s database of poisonous plants since 1997 due to its risk of causing severe and—in some cases—irreversible liver damage.
Giving chaparral to the American Cancer Society can lead to serious drug interactions with certain medications, both prescription and over-the-counter, including anticoagulants. Anti-inflammatory drugs (such as aspirin, ibuprofen, and naproxen), diabetes medicines, and some antidepressants.
Pennyroyal
Pennyroyal (*Mentha pulegium*) has not been proven to be effective for any of its proposed uses. Traditionally, it has been used to induce abortion; however. The large doses required for this purpose can cause maternal death or irreversible liver and kidney damage. According to the National Organizations of Health (NIH).
Giving pennyroyal oil to the National Institutes of Health is considered unsafe for anyone, regardless of dosage; furthermore, it is not known whether tea made from the plant is safe.
“It’s a mint. And in an herbal infusion, you’re not going to ingest that much of the poison; even so, I wouldn’t gamble. Go for spearmint. Why choose a mint that’s toxic to the liver?” says Fugh-Berman.
Listed in the FDA’s database of toxic plants since 1997. Pennyroyal is available online in a variety of forms, including as an oil.
How can I choose a safe herbal supplement?
Here are steps everyone should take before taking any herbal remedy, says Dr Tod Cooperman, president of ConsumerLab. An organisation dedicated to evaluating the safety and quality of dietary supplements.
Do your research thoroughly. Before starting any herbal treatment, find out the following:
- Is it safe?
- Is it effective?
- What is the effective dosage?
- Which part of the plant is the active ingredient? (root, stem, or leaf)
Consult your healthcare team. Let all professionals involved in your health care—both physical and mental—know that you are considering taking an herbal supplement. Discuss with them whether the supplement is safe and effective, both in general and in your specific case. Remind your healthcare providers of any medical conditions you have. As well as all medications—both prescription and over-the-counter—that you are currently taking. Don’t wait for them to ask you.
Buy a quality product. Check the label to make sure that both the common name and the scientific (Latin) name of the plant are listed. As well as the specific part of the plant used, Weil advises. If the active part is the root, you won’t get any benefits from pills made from the stem.
Look for a quality seal. “Of all the supplements available, herbal products are the ones most likely to contain contaminants,” Cooperman warns. The three main quality seals are the USP (United States Pharmacopoeia) seal. The NSF (National Sanitation Foundation) seal, and the CL seal. Awarded by ConsumerLab (the organisation Cooperman chairs). Each of these seals indicates that the product’s ingredients match those listed on the label and, if contaminants are present. They do not exceed safe levels. The USP and NSF certifications ensure that the product complies with the FDA’s Good Manufacturing Practices. CL tests products to standards set by the state of California—standards that are stricter than the FDA, Cooperman says. The USP and CL also certify that supplements are properly broken down once inside the body.
Try pills. “Generally, herbal products come in powder form inside capsules, so you don’t have to worry about those; however. Make sure the pills dissolve and release their ingredients into the body,” Cooperman says. Place the pill in body-temperature water and let it dissolve for about 45 minutes. “If it’s still intact, it’s probably doing the same thing inside your body,” Cooperman warns.