Department of Nutrition

THE NUTRITION CONSULTATION SERVICE

Guidelines for Evaluating the Safety and Risks of Herbal Mixtures

Herbal cures make up a big part of the trend towards alternative and complementary medicine. Makers of herbal cures offer many claims about their products. These claims draw people who believe herbal cures are a useful and safe option to use in place of, or with drugs prescribed by doctors.

History tells us, herbals are important for the treatment of illness. In fact, the study of herbs has served as the basis for modern-day pharmacology. But people are often not aware of the possible problems that can be caused by herbal cures.

Herbal cures are not well controlled with proven standards. Herbals have been placed in the same group as vitamins and minerals. Because of this, they can be advertised and sold without proof of their safety or benefit.
The strength of a plant’s pharmacologic (drug) level may vary by where it was grown, how it was farmed, and how it was stored.
Long storage times can cause a loss of pharmacologic (drug) strength.
Storage in hot and humid areas may result in mold growth or bacterial growth that can cause disease.
Herbal cures may not list all of the items that may cause health problems, such as steroids, anti-inflammatory agents, hormones, lead, mercury, and arsenic.
Herbal cures brought in from countries, such as China and India, seem to have higher rates of contamination.
Herbal cures can cause harmful and unexpected reactions.
Drug interactions between herbal cures and other drugs are known to exist but are not well understood.
Because herbal cures can cause adverse reactions, and interact with drugs and nutrients, you should tell your physician if you are taking herbal cures.
People who use herbal cures all the time – whether they are healthy or not – can have complications linked to treating themselves.
Infants, children, and the elderly are more likely to have an adverse reaction to herbal cures because they are less able to metabolize (break down) or excrete (get rid of) the active agent.
Certain herbal cures can also be harmful if you are going to have surgery.
If you are going to have surgery, you should:
- Stop taking all supplements (herbal cures, foods with additional nutrients outside of your usual diet) at least two weeks before surgery
- If there is not enough time to stop taking the herb or supplement, bring the product in the original bottle or box to the hospital or surgery center with you.
- If emergency surgery is needed, make sure that you tell the surgeon and anesthesiologist of the herbal cure and/or supplement that you are taking.

*It is recommended by the American Society of Anesthesiologists that ALL herbals should be discontinued 2-3 weeks prior to having surgery

safety guidlines

Use only standardized extracts of herbal cures. Buy products that list what plants are in them and how much.
Choose herbal cures made by companies whose products are carefully prepared, standardized, and made with quality controls. Some examples include Centrum®, One-A-Day®, Nature’s Herbs® (TwinLab®), Nature’s Way.
Use recommended, conservative doses. This is very important! Making your own tinctures (dilute mixtures) or a tea from loose herbs makes it hard to know the standardized dose.
Avoid herbal cures if you are:
- Pregnant
- Breast feeding
- Attempting to become pregnant
- < 18 years of age
- > 65 years of age
- Immunocompromised

Remember: All herbal cures could possibly:

Interact with other drugs (prescription and over-the-counter)
Cause life threatening side effects
Cause allergic reactions.

Talk to a medical doctor before taking any herbal cure– especially if you have a chronic disease or are routinely taking prescription drugs.

Although all herbal cures have unknown risks, there are certain herbs that are known to have potentially harmful side effects:
Herb	Why it is used	Reasons for caution

Aconite, (e.g. Bushi)	Pain, rheumatism, headaches	Numerous poisonings in China
Aloe Vera	Wound healing, Laxative	Diarrhea, nausea, vomiting
Astralagus	Immune stimulant	Autoimmune disease
Belladonna	Spasms, Gastro intestinal pain	Contains toxic alkaloids, including atropine
Black Cohosh	Reduces symptoms of Menopause, PMS, Dysmenorrhea, and Dispepsia	nausea, vomiting, uterine contractions, may induce labor
Blue Cohosh	Menstrual ailments, Worms	May induce labor
Borage	Coughs, Diuretic, mood booster	May contain liver toxins and carcinogens
Broom	Intoxicant, Diuretic, Heart problems	May slow heart rhythm; contains toxic alkaloids
Chaparral	Arthritis, Cancer, Pain, and Colds	May cause Hepatitis or Liver failure
Comfrey	Cut, Bruises, and Ulcers	Contains toxins linked to Liver disease and Death
Echinacea	Immune booster	Caution with progressive systemic diseases, such as TB, Leucosis, collagenosis, MS, HIV and autoimmune disease. Poor wound healing and increased opportunity for infections post surgery. May offset the effects of Corticosteroids and Cyclosporine
Ephedra (Ma Huang)	Stimulant, Vasodiator, Decongestant	Contains cardiac toxins resulting in dozens of deaths. May induce insomnia, stroke, high blood pressure, irregular heart beat, heart attack when paired with other stimulants or MAOI’s
Garlic	LDL cholesterol reducer	GI symptoms, increases the effects of anti-hypertensive medications and anticoagulants, prolongs bleeding and clotting times
Germander	Aid Digestion, Fever	Contains stimulant that may cause heart problems
Ginkgo Biloba	Memory deficits, Dementia	Can cause bleeding or stroke. Caution with Coumadin, aspirin, and Vitamin E
Ginseng	Energy booster	Increases heart rate and blood pressure. May decrease effects of Coumadin
Goldenseal	Immune Booster, Dyspepsia	Nausea, vomiting, paralysis, Increased blood pressure Respiratory/Liver failure
Kava-Kava	Sedative	Hallucinations, shortness of breath, dermatitis, may worsen Parkinson’s disease. Can cause over sedation when combined with Alcohol, Sleeping aids. Caution w/ anti-psychotics.
Kombucha Tea	AIDS, Insomnia, Acne	Can cause liver damage, intestinal problems and death
Licorice	Diuretic	Headache, Hypokalemia, Hypertension, Edema
Lobelia	Mood-booster, Respiratory stimulator	Large doses can cause rapid heartbeat, coma and death
Passion flower	Sedative	Seizures, Hypotension, Hallucinations
Pennyroyal	Stimulant, gastric distress	Liver damage, convulsions, abortions, coma and death
Poke Root	Emetic, rheumatism	Low blood pressure, respiratory depression
Sassafras	Stimulant, sweat producer, syphillis	Contains the carcinogen safrole. Banned from use in food.
Scullcap	Tranquilizer	Can cause liver damage
St. John’s Wort	Depression	Increases effects of anesthesia or narcotics. Induces drug metabolizing enzymes. Caution with MAOI’s
Valerian	Sedative	Increases effects of anesthesia, Hepatoxicity
Wormwood	Tonic, digestion	Can cause convulsions, loss of consciousness, and hallucinations

COMMON HERB/DRUG INTERACTIONS
HERB	REASON FOR USE	DRUG	POSSIBLE ADVERSE REACTION
Echinacea	Immune Booster	Corticosteriods (i.e. Decadron, Prednisone); Cyclosporine (i.e. Neoral, Sandimmune)	Can offset the effects of the drugs that work to lower the working of the immune system
Ephedra (Ma huang)	Stimulant or decongestant	Caffeine stimulants; Decongestants with stimulant ingredients (i.e. phenylpropanolamine or pseudoephedrine); MAO Inhibitors	Insomnia, stroke, restlessness, high blood pressure, heart attack, irregular heart beat
Ginkgo biloba	Promotes Memory Enhancement; Helps with Symptoms of dementia	Aspirin; Coumadin; Vitamin E	Can cause bleeding or stroke
Ginseng	Energy Booster; Immune Enhancer	Coumadin	May increase risk of clots or reverse drug’s effect
Kava-Kava	Sedative, relaxant	Alcohol; Anti-Parkinson’s medications; Anti-psychotics; Sedatives; Sleeping aids	Can cause over sedation by enhancing the effects of sedatives, muscle spasms or tremors
Licorice (natural)	Diuretic	Blood pressure lowering medications	Can increase blood pressure
St. John’s Wort	Anti-depressant	Anti-depressants Many other drugs	Concern that interaction may have adverse side effects *Note*: St. John’s Wort is an inducer of drug metabolizing enzymes and can lower the drug levels of many drugs when taken concurrently – or raise drug levels of many drugs when St. John’s Wort is stopped while other drugs are continued.
Valerian	Relaxant	Alcohol; Sedatives especially benzodiazepines (Valium); Sleeping aids	Can cause over-sedation

Recommended Reference Books:

Blumenthal M, Hall T, Rister R, eds. Klein S, Rister R. trans. German E Monographs. Austin, Tex: American Botanical Council; Expected Release, August 1998.

Duke JA. Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press;
1985.
Bisset, NG, ed. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press; 1994.
Tyler V. Herbs of Choice. Binghamton, NY; The Haworth Press, Inc;1994.
Tyler V. The Honest Herbal. Binghamton, NY: The Haworth Press,
Inc; 1993
Zwicky JF, Hafner AW, Barret S, Jarvis WT. Reader’s Guide to
Alternative Health Methods. Milwaukee, WI: The American Medical Association; 1993..

Recommended Resources on Alternative and Complimentary Therapies

Internet Sites:

American Botanical Council
http://www.herbalgram.org

FDA Center for Food Safety and Applied Nutrition
http://vm.cfsan.fda.gov

Food and Drug Administration
http://www.fda.gov/fdahomepage.html

Herbal Research Foundation
http://www.herbs.org

Office of Alternative Medicine
http://altmed.od.nih.gov

RxList – Alternatives
http://www.rxlist.com/alternative.html

US Department of Agriculture Food and Nutrition Service
http://www.usda.gov/fcs/fcs.htm

US Department of Agriculture Human Nutrition Research
Center on Aging
http://www.hrnc.tufts.edu

US National Institutes of Health Office of Alternative Medicine
http://altmed.od.nih.gov/

US Office of Disease Prevention and Health Promotion
http://odphp.osophs.dhhs.gov

USDA Fraud Hotline
http://www.usda.gov/oig/hotline.html

Organizations for Information

American Botanical Council
P.O. Box 201660
Austin, TX 78720
(800) 373-7105

Rosenthal Center for Alternative/Complimentary Medicine
Columbia University
630 West 168^th Street
New York, NY 10032
(212) 543-9550

Office of Alternative Medicine
National Institutes of Health (NIH)
9000 Rockville Pike, Mailstop 2182
Building 31, Room 5b-38
Bethesda, MD 20892
(800) 531-1794

NAPALERT (National Products Alert Database Program for Collaborative Research/Pharmaceutical Sciences College of Pharmacy)
University of Illinois
Chicago, IL 60612
(312) 996-2246

Contributors:

Thomas Cimo, RD;
Virginia Forbes, RN;
Diane Meehan, Dietetic Intern;
Louise Merriman, MS, RD;
Jennifer Nelson, Nutrition Fellow;
Lisa Revitz, Nutrition Fellow;
Andrea Ronning, MA, RD

Copyright NewYork-Presbyterian Hospital 2001. All rights reserved.
This resource provides brief, general information about this health care topic. It does not take the place of specific instructions you receive from your health care providers. For answers to other questions, consult your physician or other health care provider.

THE NUTRITION CONSULTATION SERVICE

Germander

(212) 746-0838