Walk into any high street health food store and I guarantee that you’ll be able to find all manner of different herbal lotions, potions, and pills. Crushed, liquidated, capsulated, and no doubt retailing for a sizeable sum of money.

It’s understandable why this type of supplement is so popular. We’ve all been there. When modern medicine can only give you 10 minutes with a locum GP in a fortnight’s time, turning to traditional remedies promising to ‘naturally’ treat your ailments holistically can seem like a no-brainer. After all, they’re just plants. What’s the harm?

Well, there’s a few different things to be aware of, starting with how effective mnay supplements actually are

First up, know that many herbal and dietary supplements make claims that are largely unsubstantiated by scientific data. If you take a closer look at many of the websites selling these supplements, clever branding and marketing is used to legitimise these products. Attractive, slender women (think Nicole Scherzinger or Goop’s Gwyneth) front such campaigns, with their healthy ‘glow’ in all likelihood owing more to good genes and clever airbrushing than it does a supplement.  Top tip, if any health claims are based on anecdotal hearsay (eg. “I always felt so tired, until I discovered magical herb X!”) rather than efficacy-based research (e.g. “trials showed 70% of women reported an improvement in feelings of fatigue after a month”) you should smell a rat.

On this note, always remember that supplements – whether herbal or micronutrient ones – are big business. These are probably not hand-picked by native Amazonian tribes during the full moon, using ancient methods used for thousands of years. Although the figures are estimates, surveys suggest that roughly 20% of Europeans and half of all Americans use such products. In the USA alone, sales of supplements were just short of $37 billion dollars in 2014.

Safety is also a concern

The ‘natural’ origins of herbal products often gives us a false sense of security. But always remember that arsenic is also ‘natural’. A recent article in The Lancet noted an alarming increase in liver toxicity attributed to these products in the US. Although it's important to note that the US dietary supplement industry is a very different beast to the UK one, in 2013-14, some 20% of drug-induced liver injury cases were attributed to supplement use, up from 7% - a figure that’s even higher in other parts of the world (70% in Singapore for instance).

Moreover, given that supplements are so readily available straight off the shelf, patients rarely disclose to their doctor that they’re taking supplements, even though it’s absolutely possible for these to interfere with other medication. St. John’s wort for instance, commonly taken as an anti-depressive, interferes with the contraceptive pill. Vitamin K, an effective clotting agent, can have a serious and potentially dangerous interaction with anticoagulant medication such as warfarin, which is often prescribed to those deliberately trying to thin their blood.

It should also be noted that a general lack of regulation around many such products means that any harm may not even be down to the herbs themselves. Products can be spiked with pharmaceuticals not disclosed on the labels or contain toxic substances like DDT as a recent Australian review reported.

Mostly for this reason, be very careful of ordering anything online. In the US, there’s a large and very grey area in terms of who regulates products that can be considered both a food or a drug. There’s no FDA approval process, or even official tests for efficacy and (crucially) safety for supplements in the States. The FDA’s attempts to bring dietary supplement regulation in line with legal requirements for food catastrophically failed in the early 1990s, after facing bitter opposition from a coalition of industry and civil society opponants.

And a special shout out for Adaptogens – the new kid on the block

These may sound like cast members of the new Marvel superhero film, but adaptogens are actually a type of phytonutrient – naturally occurring plant chemicals - that allegedly help manage stress by improving the body’s ability to keep everything nice and stable. But (and it’s a GIANT but) this is NOT an EU accepted term.

When the European Medicines Agency last reviewed the evidence in 2008, most of the existing studies on these little compounds had to be dismissed due to methodological flaws in the study designs (for some reason, these studies mostly date back to the 1970’s in the then USSR...). So the term is not accepted clinically speaking, and any so-called miracle claims for these compounds smells suspiciously to me like a well marketed Superfoods 2.0 scam. Aka #nutribollocks.

As the nutrient of the moment, be wary of articles in the mainstream press proclaiming the power of adaptogens if none of the ‘here comes the science bit’ expert quotes come from registered nutritionists or dietitians. The last article I read on adaptogens, quoted a ‘raw food and detox expert.’ Hmmm….

So what’s the solution?

It’s a pretty natural human reaction to use the past to justify the present. But just because something is labelled as natural, and sold as an ancient remedy, doesn't necessarily mean it's going to be effective or even safe.

While we absolutely shouldn’t dismiss the power of plants, eating a variety of fruit and veg is always going to be safer (and cheaper!) than buying adaptogenic or herbal powders and products. These may promise miracles, but do you know what else will replenish, reinvigorate and revitalise? A long walk outside, a good meal, and a decent night’s sleep.

Having said all that, there’s no one-size-fits-all in nutrition and health. If you’re taking a herbal supplement, don’t mind the cost, and feel better for it, then by all means continue. Just please make sure it’s from a legal, regulated, source and you practice full disclosure with your GP!

References

Herbal assault: liver toxicity of herbal and dietary supplements, The Lancet Gastroenterology & Hepatology, 2018.

Price, C. (2016) The Vitamin Complex. London, Oneworld Publications, pp. 120 – 215.

http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003646.pdf