By SUSAN H. THOMPSON/Tampa Tribune Originally published Nov. 8, 1997 TAMPA - Sixty-four-year-old Bobby Smith is a typical herb buyer. Retired and with time to spend hours on his mission, he is seeking relief among the bottles of herbal products that line the shelves of a north Tampa health food store. Smith has an enlarged prostate, a condition common to men his age that causes him to rise several times a night for trips to the bathroom but makes it difficult to urinate. A prescription drug might take care of the problem, but Smith wants none of it. The drug, he has heard, might cause impotence. So he's putting his faith and his money in saw palmetto berry extract, a top seller among herbal remedies in the United States. So he's putting his faith and his money in saw palmetto berry extract, a top seller among herbal remedies in the United States. A month's supply cost him about $35. "A friend of mine at church told me about this and says he's had great success, just terrific success with this," says Smith. Like Smith, Americans learn about herbal remedies not from their doctors and pharmacists but through the grapevine. They're willing to listen - and buy - in a big way. A survey for Prevention magazine earlier this year showed that an estimated 60 million adults in the United States are using herbs to treat illnesses, fueling a $3.24 billion market for herbal health products. Forty-one percent of Americans learn about herbal remedies through friends and family, the No. 1 source of information, according to the Prevention survey. Only 9 percent learn about herbs from their doctors, and pharmacists are a source for a paltry 4 percent, says the survey. News about herbs for health seems to be everywhere, trumpeted across front pages and on television. Last month, ginko biloba got attention with reports of a study that showed the herb modestly improved mental functions in Alzheimer's patients. Last summer, health food stores across the country found their stocks of the herb St.-John's-wort quickly depleted after the television show "20/20" reported the herb is as effective as prescription antidepressants in treating depression. Today, herbs are sold just about any place - at drugstores, supermarkets and even convenience stores. Discount stores such as Wal-Mart have shelves full. And then there are health food stores, the traditional marketplace for herbs, which offer scores of herbal teas, tinctures, pills and extracts. The choice can be dizzying and confusing for the uninitiated. What to take? How much and for how long? Which brand? And, ultimately, is it safe? The bottom line is that in today's market, consumers must find their own answers. In the United States, sales of herbs are largely unregulated in comparison with prescription drugs. A 1994 law, the Dietary Supplement Health and Education Act, ensured Americans have the freedom to choose to take herbal supplements (and others, such as vitamins) without a doctor's order. It also put in place a striking difference between the Food and Drug Administration's authority over prescription drugs and herbal remedies. Pharmaceutical drug manufacturers are required to prove that their prescription medicines are both safe and effective, a process that costs millions of dollars and takes years. That is not necessary for herbal products, which are treated as supplements under the law. With supplements, the FDA bears the burden of proof if it wants to take regulatory action. It must prove that a product is unsafe. The law opened a floodgate for new herbal products that coincided with a growing desire of many Americans to take charge of their own health, with a greater interest in preventive care. But some are worried about the public's ability to handle the freedom to treat themselves with herbal products. "It [an herbal supplement] can't be toxic and it's not supposed to be false and misleading," says Jerry Hill, chief of pharmacy services for Florida's Department of Health in Tallahassee. "But it looks like a drug, sometimes it's in a capsule or liquid and it implies health benefits in some manner. And the thing you need to know, it does not as a dietary supplement have to be proven safe and effective." Herbal supplement makers are, however, limited as to what claims they can make for their products. The result is that bottles and packages often aren't labeled as to what they're for. For instance, this nonspecific description can be found on a bottle of feverfew, an herb often used to treat migraines, at a local health food store: "Feverfew is currently the subject of a great many research projects around the world." A 1995 report in Consumers Report called buying herbal supplements "herbal roulette," because buyers can't be assured of what they're getting. The magazine's analysis of 10 ginseng products revealed that the amount of ginsenoside varied widely from each product to the next, with one containing hardly any, even when the active ingredient labels were similar. At Bertha's Nutrition Shoppes in south Tampa, "Prescription for Nutritional Healing," a thick and well-thumbed self-help book for choosing supplements according to health conditions, is anchored near the checkout counter for customers to flip through. Customers there also rely on store manager Alyse Cavanaugh to steer them in the right direction. Cavanaugh has worked in the health food industry for 22 years. "What I find in Tampa is that the people here are really media-oriented. If the media says milk thistle is really good for your liver, the whole world comes in and wants milk thistle," she says. Cavanaugh tries to discourage people from taking many kinds of herbs continuously. Some of her customers, she says, are taking eight different herbs each day, as if they were vitamins. "Our forefathers used herbs and roots. But they didn't take them on a daily basis," says Cavanaugh, who also warns her customers that prescription drugs and herbs don't mix. That's a message that Michael Cirigliano, a physician and professor of medicine at the University of Pennsylvania Medical Center, emphasizes. Cirigliano tells people that they shouldn't self-treat with herbs, that many conditions are likely to require an evaluation by a health care practitioner first. "Basically, what I tell all my patients is that they really need to tell their doctors whether they're on them [herbal supplements]. Certain herbs have some interaction with pharmaceuticals," says Cirigliano. For instance, St.-John's-wort, popular for treating depression, can interact with prescription antidepressants. Therefore, it's important to ease off antidepressants gradually under a doctor's supervision before taking the herb. A good example of a condition that should not be self-diagnosed is enlarged prostate, a benign disorder. That's because its symptoms can be similar to those of prostate cancer, leading to a potentially deadly mistake. "Picture this, a man in his 60s is having a little trouble going to the bathroom," says Paul Doering, a professor of pharmacy at the University of Florida. "He says, "I don't need to go to the doctor; I'll just take this saw palmetto extract.' He may not get relief from it, but in either instance, he doesn't go to his doctor until two years later when his prostate cancer is now beyond treatment." Steven Foster, who has written 11 books on herbal health, agrees with that example. "You can't diagnose your own prostate condition," says Foster, who lives in Fayetteville, Ark., and is one of the country's top experts on the use of herbs. Foster prescribes a large dose of common sense when giving advice about taking herbal remedies. "If it sounds too good to be true, you can bet it is," he says. "Read the label. Be familiar with the ingredients. Consumers must arm themselves with information and the consumer must not make the assumption that just because something is natural that it's safe." Knowing how to identify ingredients is helpful in evaluating how a product works. For instance, Foster recently spotted a remedy that said it contained milk thistle leaf. But that isn't what people should buy if they want the beneficial effects on the liver shown in scientific research, says Foster. It is milk thistle seed, not leaf, that is beneficial because it contains a chemical complex called lymarin. Many standardized herbal products are from Europe, says Foster, where in some countries herbs are widely used and prescribed by doctors. When a product is standardized, it means that from batch to batch, it contains the same level of ingredients. Learning about herbs on an individual basis is important, too. Which one you pick depends on what effect you are looking for. Ed Croom, an associate professor at the University of Mississippi School of Pharmacy at Oxford who specializes in herbal medicine, says that if he wanted results found in a clinical trial, he would use the herbal formulation used in that trial. Croom says herbs can affect people differently but adds so can food. Some food is tolerated by most people, although it might give some upset stomachs or even severe allergic reactions, he says. "I actually lived with rural people in the South, collecting herbal medicines. I went out for years with people and we gathered all kind of things and made them in teas," he says. "My point is that very few plants in moderation, and that is the key - moderation - are toxic to you." One that has sparked concern, however, is ephedra, a Chinese herb also known as ma-huang. Its compounds are used in over-the-counter medications for coughs and asthma with extensive warnings not to exceed the recommended dose. It dilates bronchial tubes and can also elevate blood pressure. Some herbal weight-loss products and stimulants contain ephedra. More than a dozen deaths in the United States have been blamed on the compounds and the FDA currently is considering proposals that will limit the level of ephedra a product can contain. In Florida, after a college student died from taking a street drug substitute that contained ephedra two years ago, state regulators asked manufacturers to add warning labels to their products and limit the amount of ephedra in them. Croom emphasizes that consumer education is key. "It's like anything in life, if you become educated, you can be a wise and rational consumer," he says. "There is a huge new freedom now ... there are products everywhere. And with that I'm saying, for the consumer comes a responsibility to learn what they're doing." For more information Books: ˆ "The Honest Herbal" by Varro E. Tyler (Pharmaceutical Products Press, $17.95) ˆ "Herbs of Choice: The Therapeutic Use of Phytochemicals" by Varro E. Tyler (Pharmaceutical Products Press, $24.95) ˆ "Herbs for Your Health" by Steven Foster (Interweave Press, $9.95) ˆ "The Green Pharmacy" by James A. Duke (Rodale Press, $29.95) Magazines: ˆ "Herbs for Your Health," published bimonthly by Interweave Press, is geared toward beginners. For subscription information, call 1-888-844-3727. ˆ "HerbalGram," the Journal of the American Botanical Council and the Herb Research Foundation, published quarterly, includes information about industry news, research and books. For subscription information, call 1-800-373-7105 or contact the American Botanical Council, P.O. Box 201660, Austin, Texas 78720-1660. Web sites: ˆ The American Botanical Council's site is www.herbalgram.org and includes an extensive list and description of books on herbal topics. ˆ The Herb Research Foundation is at www.herbs.org Susan H. Thompson is a feature writer in the Tampa office. Reach her at (813) 259-7951 or e-mail shthompson@tampatrib.com
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