As a community pharmacist, I often witness a peculiar trend: the romanticization of natural remedies and the vilification of "chemical" medicines. It’s a narrative that paints one as inherently good and the other as bad. But is it really that simple?
Let me share a story. An 18-year-old acquaintance once asked me for advice on losing weight. I recommended a low-dose, FDA-approved medication called Orlistat to support his efforts. His response? "I’d prefer something natural—maybe a remedy to make me vomit after eating." While vomiting might seem "natural," it is also extremely risky and harmful. This misconception—that natural equals safe—underpins much of the misguided enthusiasm around herbal and dietary supplements (HDS).
Breaking the Myth: Natural vs. Chemical
Did you know many life-saving medicines have natural origins? Antibiotics like penicillin, cholesterol-lowering drugs, and others, yet their transformation into "chemical" medications is what makes them safe and effective.
Conversely, natural substances aren't inherently harmless. Some herbal treatments, like Aristolochia (marketed for treatment of dry cough, inflammation, short breath in children,) are toxic to the kidneys and linked to cancers. Others, such as Kratom, marketed for opioid withdrawal, carry themselves the risk of addiction, psychosis, and even death.
When it comes to health, the line between natural and chemical isn’t black and white. It’s about evidence, safety, and informed use.
Herbal and Dietary Supplements (HDS) Popularity
A study in JAMA revealed that almost 60% of Americans use herbal or dietary supplements. While some supplements may offer benefits, their advantages are often exaggerated, and the potential risks, including their financial cost, are frequently downplayed. Let’s take a closer look at some commonly used supplements to distinguish between fact and fiction.
Chamomile
For centuries, chamomile has been used for anxiety, digestive issues, and sleeplessness. Some animal studies suggest it may have anti-inflammatory and anticancer effects, but human trials haven’t confirmed these yet.
Benefits: Chamomile tea may help with mild anxiety and insomnia.
Limitations: Its effects on generalized anxiety disorder remain inconsistent, with some studies showing benefits while others don’t.
Risks: Chamomile can interact with blood thinners like warfarin, increasing bleeding risk. Those with estrogen-sensitive conditions should be cautious as well.
Capsaicin
Found in chili peppers, capsaicin is used in topical creams for pain relief.
Benefits: FDA-approved for joint and nerve pain relief.
Limitations: Other medications, like Diclofenac, are better tolerated and more effective.
Risks: Minimal, though it can cause a burning sensation upon application.
Garlic
A common kitchen ingredient, garlic is often linked to heart health and cancer prevention.
Benefits: Some studies suggest garlic may help lower blood pressure.
Limitations: Research on its effects on cholesterol, blood pressure, and cancer prevention is inconsistent, with many studies failing to confirm its benefits.
Risks: Garlic supplements can increase bleeding risk, so it’s important to consult a healthcare provider before surgery or when taking blood thinners.
Ginkgo Biloba
This ancient herb is popular for its supposed memory-enhancing effects.
Benefits: Some research suggests it might support cognitive function in older individuals.
Limitations: Evidence is mixed, with many studies showing little or no impact on memory or dementia.
Risks: Ginkgo may increase bleeding risk, especially in those on blood thinners. Rare cases of seizures have also been reported.
Probiotics
Probiotics are often used for gut health, promoting digestion and overall gut function.
Benefits: Clinical evidence shows that probiotics can help with irritable bowel syndrome and diarrhea caused by antibiotics.
Limitations: The evidence for their benefits in other conditions is weak. Many claims about probiotics—such as boosting immunity, improving mental health, or their benefit in other kinds of diarrhea —lack scientific support.
Risks: Probiotics may pose risks for immunocompromised individuals, including infections or antibiotic resistance transfer.
Curcumin (Turmeric)
Known for its anti-inflammatory properties, curcumin is often used to manage joint pain and inflammation.
Benefits: Some small studies suggest curcumin may reduce inflammation and pain associated with arthritis.
Limitations: Curcumin is poorly absorbed in the gut and large studies are still needed to confirm its clinical effectiveness.
Risks: In rare cases, curcumin has been linked to liver toxicity, especially when supplements are used to enhance absorption.
The Hidden Dangers of HDS
Despite their widespread use, supplements aren’t subject to the same rigorous regulations as pharmaceuticals. Research has revealed concerning inconsistencies in product labeling, purity, and ingredients:
Up to 30% of tested products contain unmentioned ingredients.
Some supplements have been found contaminated with harmful substances like lead, mercury, or arsenic.
Adulteration is common, with products containing unlisted pharmaceuticals or banned substances like steroids or pharmaceutical ingredients for sexual arousal.
These hidden risks underscore the need for caution. For example, weight-loss supplements marketed as “natural” have been found to contain harmful ingredients like laxatives or drugs that have been recalled, posing serious health threats.
Regulation is Key
Unlike medications, dietary supplements don’t need FDA approval before hitting the market. Manufacturers are responsible for ensuring safety and accurate labeling, but enforcement is reactive, not proactive. This regulatory gap leaves consumers vulnerable to mislabeled or contaminated products.
Even supplements with some scientific backing can vary greatly in effectiveness from one brand to another due to differences in quality control, dosages, and ingredients.
Takeaway Points
When considering natural remedies or supplements:
Examine the Evidence: Many supplements offer limited or inconsistent benefits, so manage expectations.
Consult Your Doctor: This is especially important if you have underlying health conditions or take other medications.
Be Critical of “Natural” Claims: Just because something is labeled as natural doesn’t automatically make it safe or effective.
While some supplements can offer some benefits, their risks and lack of stringent regulation should make us cautious. Until regulations improve, staying informed and consulting with healthcare professionals is the best way to protect ourselves from potential dangers.
References:
Chamomile: Usefulness and Safety. (n.d.). NCCIH. https://www.nccih.nih.gov/health/chamomile
Dietary supplement fact sheets. (n.d.). https://ods.od.nih.gov/factsheets/list-all/
Garlic: Usefulness and Safety. (n.d.). NCCIH. https://www.nccih.nih.gov/health/garlic
Ginkgo: Usefulness and Safety. (n.d.). NCCIH. https://www.nccih.nih.gov/health/ginkgo
Herbs at a Glance. (n.d.). NCCIH. https://www.nccih.nih.gov/health/herbsataglance
Turmeric: Usefulness and Safety. (n.d.). NCCIH. https://www.nccih.nih.gov/health/turmeric
UpToDate. (n.d.-b). UpToDate. https://www.uptodate.com/contents/lipid-management-with-diet-or-dietary-supplements?sectionName=Supplements%20that%20we%20do%20not%20recommend&search=herbal%20supplements&topicRef=1392&anchor=H3514167012&source=see_link#H3514167012
UpToDate. (n.d.-d). UpToDate. https://www.uptodate.com/contents/complementary-and-alternative-treatments-for-anxiety-symptoms-and-disorders-herbs-and-medications?sectionName=Chamomile&search=herbal%20supplements&topicRef=1392&anchor=H2255854&source=see_link#H2255854
UpToDate. (n.d.-e). UpToDate. https://www.uptodate.com/contents/overview-of-herbal-medicine-and-dietary-supplements?search=herbal%20supplements&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1 Assessed and Endorsed by the MedReport Medical Review Board