Herbal supplements: What to know before you buy

Herbal supplements may be popular, but are they for you? That depends on the herb, your current health and your medical history. Herbal supplements have active ingredients that can affect how your body functions, just as over-the-counter and prescription drugs do. Herbal supplements may be particularly risky for certain individuals, and their labels are often vague, confusing and of little help when it comes to making a selection. If you're considering herbal supplements, educate yourself about any products you intend to use before purchasing them, and talk to your doctor about any herbal supplements you're considering taking.

Are herbal supplements safe?

The Food and Drug Administration (FDA), the federal agency responsible for overseeing the safety of U.S. food and drug products, doesn't have the authority to approve herbal supplements before they're sold. While herbal supplements are supposed to contain what their labels claim, that isn't always the case. When buying herbal supplements, keep in mind that government oversight and consumer protection is very limited when it comes to these products.

However, despite the general lack of oversight, you can expect certain information to be included on the labels of all herbal supplements, which should help you understand what's inside the packaging. This information includes:

• The name of the herbal supplement, such as St. John's wort
• The net quantity of contents, for example, 60 capsules
• In certain cases, a disclaimer: "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."
• A Supplement Facts panel, which includes serving size, amount and active ingredient
• Other ingredients, such as herbs and amino acids, for which no daily values have been established
• The name and address of manufacturer, packer or distributor

Manufacturers typically refer to herbal products by their common name and the part of the plant used to make the herbal supplement, such as root, stem or leaf. If you don't understand anything on an herbal supplement's label, ask your doctor or pharmacist for clarification.

How do you choose an herbal supplement?

The limited amount of regulation makes choosing an herbal supplement of the highest quality a difficult prospect. In order to choose the best herbal supplement brands:

• Look for standardized herbal supplements. The U.S. Pharmacopeia's "USP Dietary Supplement Verified" seal on a supplement indicates the supplement has met certain manufacturing standards. These standards include testing the product for uniformity, cleanliness and freedom from environmental contaminants such as lead, mercury or drugs. Other groups that certify herbal supplements include ConsumerLab.com, Good Housekeeping and NSF International. Although each group takes a slightly different approach, the goal of each is to certify that herbal supplements meet a certain standard. Don't assume that all herbal products on the market are safe. Even the groups that test herbal supplements aren't obligated to report products that fail to live up to their standards.
• Buy only single-herb products. And choose products that clearly show how much of the herb each dose contains. Some products are mixtures of several herbs with unknown proportions of each.
• Beware of claims that sound too good to be true. If a claim sounds outrageous to you, trust your instinct. No one herbal supplement can possibly address a wide spectrum of health concerns.
• Be extremely cautious about herbal supplements manufactured outside the United States. Many European herbs are highly regulated and standardized. But toxic ingredients and prescription drugs have been found in some herbal supplements manufactured in other countries.

Who shouldn't use herbal supplements?

Avoid using herbal supplements if:

• You're taking prescription or over-the-counter (OTC) medications. Some herbs can cause serious side effects when mixed with prescription and OTC drugs such as aspirin, blood thinners or blood pressure medications. Talk to your doctor about possible interactions.
• A proven medical treatment is available for your medical condition. A traditional medication with an established record for safety and effectiveness will generally be less likely to result in adverse side effects.
• You're pregnant or breast-feeding. As a general rule, don't take any medications — prescription, OTC or herbal — when you're pregnant or breast-feeding unless your doctor approves. Medications that may be safe for you as an adult may be harmful to your fetus or your breast-feeding infant.
• You're having surgery. Many herbal supplements can affect the success of surgery. Some may decrease the effectiveness of anesthetics or cause dangerous complications such as bleeding or high blood pressure. Tell your doctor about any herbs you're taking or considering taking as soon as you know you need surgery.
• You're younger than 18 or older than 65. Older adults may metabolize medications differently. And few herbal supplements have been tested on children or have established safe doses for children.

Discuss herbal supplements with your doctor

Always talk to your doctor before taking herbal supplements. Your doctor can tell you whether:

• Any herbs you take or are interested in taking have potentially dangerous side effects
• Specific herbal medicines are appropriate for you given your overall health status
• Any herbal medicines can interact with other medications you currently use
• You could achieve the same results you desire from herbal supplements by changing your lifestyle — for example, your diet or exercise program

Your doctor may be cautious about endorsing or embracing most herbal supplements. This is often because relatively few controlled studies have been done on herbal supplements. However, a growing number of doctors are working to better understand herbal therapies so that they can help you make informed decisions about your health care. If your doctor isn't comfortable discussing herbal supplements with you, ask for a referral to a pharmacist or specialist who is knowledgeable in this area.

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