Is Natural Good?

An Orange County store I frequent prides itself on bringing “you the finest organic and natural foods.” But, when one enters it is not the fruits and vegetables that dominate the scene. Rather, there are aisles and aisles of pills—“natural” supplements.

According to the National Center for Complementary and Alternative Medicine (NCCAM) Guide to Herbal Supplements, nearly 20% of Americans have used a herbal supplement in the last year. The same source says that it is vital to be an “informed user” and that “natural does not always mean safe.” In fact, because herbal supplements are not FDA regulated, they do not need to meet any standards of purity or strength. And, because people are under the impression that natural means safe, they often do not realize that herbal supplements may have side effects, and can and do interact with prescription and over-the-counter medications, with possibly life-threatening results.

Let’s look at just a few herbs: St. John’s Wort, which is touted to be useful in treating depression; Echinacea, which is said to prevent colds and boost immune system function; Hoodia, which is sold to overweight women for its alleged appetite suppressant qualities, and PC-SPES, which was sold by Orange County’s BotanicLab as a treatment for prostate cancer. Two questions: do these herbs work and are they dangerous?

The NCCAM’s afore-mentioned guide is very helpful as a source of information about the most popular herbs. There it says that St. John’s Wort has not been demonstrated to be more efficacious than placebo in treating moderate depression. However, it does cause all kinds of side effects, including headache, sexual dysfunction, and stomach problems. In addition, it has adverse interactions with prescription anti-depressants, birth control pills, heart medications, HIV medicines, seizure medications, blood thinners, and some cancer treatments. This is a significant list of problems for something that has not even been shown effective.

Likewise, Hoodia has not been shown to be help with weight loss or appetite depression. Nonetheless, tens of thousands of desperate women and men are using it. On the possibly positive side, there have been no studies showing that Hoodia has side effects. But, that is because there have not been any studies, not because it doesn’t. Interestingly, many of the products that say they include Hoodia actually don’t. It would appear that folks do not notice because the only effect Hoodia has is as a placebo (more on this next month).

What about Echinacea? Apparently, the jury is still out on whether it actually works to prevent or treat infection, but there is no doubt that it can cause allergies. In addition, it has been “found that of 11 brands of echinacea purchased for testing, only 4 contained what was stated on their labels. About 10% had no echinacea at all; half were mislabeled as to the species of echinacea in the product; and more than half of the standardized preparations did not contain the labeled amount of active ingredients.” But, again, does it matter if it doesn’t work anyway?

PC-SPES did work in prostate cancer, but this was because of the estrogen surreptitiously added by the manufacturers. This “herb” was eventually withdrawn from the market because it was not only contaminated with artificial estrogen, but also with a blood thinner. The company was closed.

It is obvious that we have a problem. When “dangerous herbal remedies can be hyped on the Internet, embraced by desperate patients and legitimized by research institutions” (Washington Post 9/5/04), lives are put at risk. Natural does not always mean effective and it certainly does not mean safe. At best, many of the “natural” products shown above are a waste of money; at worst, they can be life-threatening