As untested remedies spring full-bloom into Americans' consciousness and medicine chests, researchers suggest a measure of caution when it comes to... Herbs

January 20, 1998|By Patricia Meisol | Patricia Meisol,SUN STAFF

Betty Grimes' conversion began two years ago after a terrible flu. She credits her good health since then to daily doses of echinacea, ginseng, garlic and ginkgo biloba, plus vitamin E. Now the retired sales manager busies herself converting others to what some call a new American religion: herbalism.

"Echinacea is real good," Grimes told a customer examining bottles of herbs at Drug City Pharmacy in Dundalk recently. "Soon, everybody will be on it."

But salvation in this new religion may be an illusion. Even though the medicinal value of herbs has been known and mined in Asia and Europe for thousands of years, Americans are using them in unsupervised and untraditional ways with potentially worrisome consequences.

They are mixing them with prescription drugs without knowing the effects, taking unstudied dosages and, in some cases, buying versions with suspect potencies. They are spending billions even before the full chemistry of many of the herbs has been analyzed.

"We don't have the traditional understanding of the safety of herbs that we are accustomed to [with] over-the-counter drugs," says Bernadette M. Marriott, director of the Office of Dietary Supplements at the National Institutes of Health.

The appeal of herbs has been sudden and phenomenal: Sales have tripled to more than $3 billion in a decade. But despite this apparent paradigm shift in medicine, with millions of consumers like Grimes eagerly taking herbs as a preventive measure, American researchers have only begun to assess whether the herbs work. The result is: Consumers can expect little or no guidance from the government as big companies pour out herbal products.

The number of products with "herbal" in the title has doubled to more than 1,000 since 1993, when some of the biggest herb companies united with consumer groups to persuade Congress to exempt herbs and nutrients from Food and Drug Administration oversight. The groups feared that a tougher regulation such as that required of new drugs would mean a ban on herbs known to be beneficial but never tested.

But what are people buying? With no standardization -- indeed, no agreement on proper doses -- it's anybody's guess.

"Some herbs and vitamins are junk," says Mark Litchman, co-owner of Drug City and a self-taught expert on alternative medicines.

Australian tests have uncovered a wide variation in quality of herbs sold around the world. For example, some brand-names of garlic contain little or no allicin, the ingredient thought responsible for lowering cholesterol.

Ginseng sold in $1 vials at health food and convenience stores may contain up to 34 percent alcohol, according to a recent report by the U.S. Bureau of Alcohol, Tobacco and Firearms, which is seeking a product recall.

For some herbs, scientists have yet to pinpoint the active ingredient. The state of herb research is chaotic, making conclusions difficult. A single herb may be the subject of 50 to 300 papers, all on different alleged health benefits. When two or more papers cover the same topic -- say, gingseng's value as a sleeping aid -- researchers may have tested different species or different plant parts -- stem, petal, root. Sometimes the biggest scientific advance from reviewing available studies is simply to clear up which species was studied. In short, reviews of the research usually end by pointing up the need for more research.

Consumers also are on their own when it comes to quantity. For example, some research suggests that people eat six to 12 raw cloves of garlic a day to prevent cholesterol buildup in the arteries; another report recommends one to two cloves daily. Only raw garlic will do, some say; others say freeze-dried is OK, too.

Many people take echinacea every day, to help the body fight colds, but most brands suggest taking it only at the first sign of a cold and continuing it for no more than eight weeks. Some druggists advise a dose for only 10 days at a time because the herb's effect diminishes with regular use. At a 1996 Florida symposium, German researchers said their own common practice of prescribing echinacea for a two-week period followed by a week of abstinence had never been tested in humans.

Too much of a good thing

That herbs have a medicinal value is not in question -- they're a staple in various cultures because they often cost less, are more convenient and have fewer side effects than prescription drugs.

But in these cultures, their use is very specific.

The same way U.S. doctors prescribe drugs, Chinese doctors prescribe herbs -- typically after an examination of the patient and review of the patient's history.

"It's very rare that a health-care practitioner would say, 'Take one for the rest of your life, or even two years of your life,' " says Marriott at NIH.

The possible complications from mixing herbs and prescriptions has persuaded her to push for a new blank on medical forms to allow patients to report herbs they use.

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