Words by: Bethan Grimshaw

Whether it’s tumeric tablets or rescue remedy, chances are you have used a so-called “herbal” or “alternative” remedy at some point. And chances are that you fall into one of two categories of thought:

  1. I don’t think this will do anything, but it’s worth a try.
  2. This definitely works and it must be safer than “proper” medicine.

Seeing old women in Holland and Barrett spending their pensions on Chlorella (a unicellular microalgae) tablets at £11 (minimum) a jar in the hope it will “enhance vitality and energy” is enough to make my blood boil. My anger is not with the consumers themselves, but at the misconceptions propagated by the media. Firstly, not only are headlines relating to herbal remedies often simply untrue (biology is not so simple that tumeric will solve all your problems), but they can be down-right dangerous.

The history

As with most things, the alternative medicine industry has its roots in Victorian Britain. Herbal remedies go back centuries, being passed down generations of families. But it was in the Victorian era that selling remedies became commercially viable. People who could not afford doctors relied on the elixirs and mixtures of “pharmacists” (quotations are used as anyone could set up a pharmacy, without any training being required). Lists of dosages and ingredients were frequently not listed. For example, “Infants Preservative”, a common over-the-counter remedy used by mothers to help their babies sleep so they could go out to work, contained such high levels of narcotics that it is repeatedly cited in post-mortem reports as the cause of children deaths. It was not until 1908 that the Pharmacy Act enforced effective control.

The dangers

Though of course there has been much advancement in health and safety since such times, regulation is still lacking. As herbal remedies are not subject to the same vigorous regulation and quality control as pharmaceutical drugs, fake, unlicensed or contaminated medicines are obtainable online. Such products can contain banned ingredients and even toxic substances. One Australian study into Chinese medicine products found 61% of samples tested contained levels of lead, cadmium and arsenic that were sufficient to cause acute poisoning. There have also been reports of herbs contaminated with pesticides, salmonella bacterium, and aflatoxin (a mould found in yeast that is metabolised by the liver to 2,3-epoxide, which causes DNA mutations and is strongly linked to liver cancer).

Then there is the danger of what effect the active ingredient will actually have. A common misconception is that because the active ingredient is derived from a plant, it is safe. This is not the case. Anything that has an effect on your body is deemed a “drug” and therefore has the potential for harmful effects. Herbal remedies are metabolised by the body in the same way as prescribed medicines. Phase 1 of metabolism involves functionalisation of the drug via oxidation, reduction or hydrolysis reactions, for example by the cytochrome p450 system (a family of enzymes) in the liver. Phase 11 metabolism involves conjugation reactions with endogenous (produced within the body) substances e.g. glucuronic acid. The rate of drug metabolism depends on many factors and varies between individuals, meaning the same concentration of drug can have deferring levels of effects.

Arguably the most dangerous thing about herbal remedies is not even what effect the drug has on the body in isolation, but the effect it has on other drugs the person may be taking, by blocking their action or increasing their potency. Such affects are called “drug-drug interactions”. A group of South-African researchers conducted a review of 49 reports of potential adverse interactions and found 59% were likely caused by interaction between prescription drugs and herbal remedies.

Well documented drug-drug interactions include:

  • Herbal remedies interfering with anaesthesia and other drugs given before/during/after medical procedures.
  • Interference with blood clotting, increasing the risk of excessive bleeding during surgery.
  • Sage, flaxseed, St John’s Wort, cranberry, goji juice, green tea and chamomile have all be found to interfere with warfarin and statins (blood-thinning drugs used to treat cardiovascular disease).
  • St John’s wort is a potent inducer of the cytochrome p450 system, meaning other drugs will be metabolised faster and therefore have reduced effect. For example, St John’s Wort has been found to have clinically significant interactions with the contraceptive pill, cyclosporine (an immunosuppressant drug), SSRIs (anti-depressants), and benzodiazepines (commonly used to treat anxiety).
  • Ginseng decreases the effectiveness of warfarin, increasing the likelihood of someone with cardiovascular disease developing a blood clot.
  • Ginkgo has been found to interact with over 250 drugs, such as aspirin.

The advice

NSH England advise the following people should not take herbal remedies:

  • Those who are taking other medications
  • Those with serious health conditions, e.g. liver or kidney disease
  • Those who are awaiting surgery
  • Women who are pregnant or breastfeeding
  • The elderly
  • Children

They further advise that, if you do decide to take herbal remedies, you check if the packing states it is THR (Traditional Herbal Regulation) approved, as this ensures the product complies with quality standards relating to safety and manufacturing, and that it provides proper information about when and how to use the product.

However, using THR approved products does not guarantee it is safe for everyone to use (it may still be harmful if used to treat more serious conditions), and claims made by such products are merely based on traditional usage rather than evidence of the product’s effectiveness.

When consulting health professionals, you should always let them know what herbal remedies you are taking, and report any suspected side-effects via the Yellow Card scheme, run by the MHPRA (Medicines and Healthcare Products Regulatory Agency).

The end

To conclude, please think carefully the next time you are contemplating trying a new herbal remedy. Do your own personal research, rather than relying on word-of-mouth or media headlines, and consult a health professional, especially if you currently take other medications. And look out for friends and family who may be vulnerable to the dark secrets of herbal remedies.

Image credit: Shirley Hirst, pixabay

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