HERBAL medicine has been practised for thousands of years. It offers hope for conditions as varied as the common cold, depression and Alzheimer’s disease. As more and more research and clinical studies become available, increasing numbers of health care professionals are beginning to recommend herbal treatments for their patients. Furthermore, there is a growing trend for the public to self-medicate using herbal supplements under the impression that herbal preparations are safe and devoid of serious side effects.
To meet the demand, a myriad of herbal preparations is available in the market. But, are all herbal supplements really safe and effective?
Regulations do not apply to all countries
In many parts of the world, herbal supplements are not regulated by the local Drug Control Authority as they are classified as foods. In Malaysia, herbal supplements have been regulated by the Drug Control Authority since 1992.
Prior to this, the importation, sales and manufacturing of herbal supplements were not subjected to any particular regulation and this resulted in many inferior and adulterated products in the market.
Even with the registration requirements, the Drug Control Authority still comes across herbal preparations contaminated with excessive heavy metals or adulterated with pharmaceutical substances. The most recent example is the herbal slimming product found to be adulterated with the banned pharmaceutical substance fenfluramine. Herbal products containing Kava-kava have also been withdrawn due to the potential damage to the liver.
All these instances point to the requirement of safety in the use of herbal preparations. The general public is more confused than ever before as all along they are under the impression that herbal preparations are safe. The Drug Control Authority is stepping up post-market surveillance on herbal preparations as well.
Speed can kill, even for herbs
Herbal preparations are generally slow in producing the desired effect. In this age of fast cars, fast food and fast bucks, instant gratification is desirable. To meet this trend, is there any wonder that certain unscrupulous manufacturers are intentionally adding pharmaceutical substances such as fenfluramine, steroids, pain killers and antibiotics to the herbal supplements to produce a quick-fix solution? It is these irresponsible manufacturers who are bringing disrepute to the herbal industry.
Potent solvent to maximise extraction
Herbal extracts are widely used in the manufacture of herbal supplements. The solvent used in the preparation of the herbal extract is of paramount importance. In many instances, strong organic solvents such as acetone or methylene chloride are used in the extraction. These strong organic solvents are able to extract many toxic, non-water soluble substances in the herbs that are not normally encountered in the traditional water decoction method of preparation.
A case in point is the recently withdrawn Kava-kava products, which used acetone for extraction. Such extracts have manifested liver damage not encountered with traditional usage.
Phytochemical or phytoceutical
Herbs usually contain a multitude of compounds, some of which are synergistic in nature. Some will ameliorate the toxic effects of other compounds, while others may influence the absorption of the bioactive ingredients by our body.
It is very important to maintain the natural balance of the various substances as close as possible to nature during the extraction process. There are many herbal extracts which claim to contain a very high percentage of active ingredients, for example 90% polyphenol in Green Tea extract. Such high percentages of active ingredient would imply that many of the other useful auxiliary substances have been removed during purification. These extracts are no more the traditional preparations but new chemical entities, the safety and efficacy of which are not proven. Is there any wonder that adverse effects are reported regarding their usage?
You get what you pay for
Due to its complex nature, there is a wide variation in the quality of herbal supplements available in the market. As with most things, there is a price for quality.
Many consumers take herbal supplements as preventive care and base their choices on price alone. If herbal supplements of inferior quality do not provide the protective effect as claimed, the consumers could be worse off because they are under a false sense of security. This is just like buying an insurance policy without knowing the fine print.
Evidenced-based products produced under pharmaceutical conditions
There are several herbal supplements that have undergone proprietary processing and clinical testing to demonstrate their safety and efficacy. Some are even manufactured under pharmaceutical conditions.
In the final analysis, it is the commitment to quality that is supported by well-conducted clinical studies that will justify the continual existence of a herbal supplement in the market.