YA Online - Herbal Remedies - are they really safe?

Publicity about herbal remedies has grown during the nineties. A number of young people with ME have asked us about these remedies - are they safe to use? do they help someone with ME? where can they be obtained? and so on.

Just as we were working on this leaflet, the former editor of the Journal of Chronic Fatigue Syndrome, tongue in cheek as usual, sent us the following over the Internet:

This amusing satire on the past 4000 years of medicine arrived at a very opportune moment. There has been a virtual explosion of interest in all kinds of alternative therapies, in particular, those which have been around for thousands of years. Naturally, in an illness where there is no "cure" and in which pharmaceutical drugs typically produce side effects, people look for other remedies.

Unfortunately, people also tend to assume that herbs are safe because they are "natural". However, we all know that plants such as deadly nightshade, laburnam or foxglove will kill us if we eat them. So the fact that something is "natural" does not, in fact, mean that it is safe. And if you are sensitive to prescription drugs, the chances are that you will be sensitive to other substances too.

The following information has been compiled by pharmaceutical expert Mike Valentine who discusses herbs and their uses, and compares them with conventional medicine.

Originally, herbs were the "above ground" parts of plants (which die back every year); these were harvested fresh and prepared for use as medicines. However, the term "herbs" now includes the raw dried herb, or the manufactured products like tablets, capsules and ointments.

Many herbs will not stand up to the scrutiny that is demanded by the committee on the Safety of Medicines. For herbs, safety is assumed through lack of reports of poisoning and side effects. Several thousand herbal medicines have been awarded product licenses of right by the Department of Health on this basis. There is no system of patient protection for reporting side effects and adverse reactions as with the Yellow Card system for conventional medicines.

No. Herbs contain natural chemicals or drugs. They have toxicity and can interact with conventional medicines. For example, St John's Wort contains a Mono Amine Oxidase Inhibitor, or MAOI. When MAOIs are used in modern medicine, there are severe limitations placed upon other medicines you can take at the same time, or what you can eat. Certain foods like Marmite, Oxo, cheese and even Chantilly wine have a high tyramine content and a potentially fatal interaction can take place with the MAOI. Some ME patients are treated with MAOI antidepressants like Nardil (Phenelazine).

There are no proven safe herbs for use in children that would stand up to the scrutiny of safety demanded with modern medicines.

Almost all herbs have been tried in the practice of conventional medicine at some time in the past and have been rejected as being ineffective and/or unsafe, or because better products are available. The modern trend is to extract the active principles out of herbs and purify them chemically under laboratory conditions. For example, Aspirin is found in Willow Bark. The amount of "active principle" in prepared herbs is influenced by climate, humidity, rain, harvesting etc. The herbs used to supply active principle in modern medicine eg Digitalis (Foxglove), Belladonna (Deadly nightshade) are closely controlled by law. Even qualified herbalists cannot use these. Taxol is extracted from Yew hedge clippings, processed and used as a treatment for certain cancers.

Generally no, for reasons of liability and accountability. If a doctor were to prescribe a herbal product which had no product licence, he would be accepting full responsibility for any consequences. Also he would not be covered by professional liability insurance. Produce licences give guidance on dosage, indications and contra-indications, interactions with other substances, toxicity etc. The most popular "herbal" product on NHS prescription is Senna. The common preparation is Sennakot tablets used as a laxative. From the leaves of the plant, the active principle, Anthroquinone, has been standardized.

When herbs are cultivated they change characteristics when compared to wild stock. Also, different climatic and soil conditions cause unpredictable variation in potency. Leave it to the experts.

Herbals may be purchased from a herbalist or health shop and should be used only as instructed on the pack. Generally these will be single ingredients. Do not mix or take more than one different herbal product at a time. A considerable number have food use, such as Dandelion.

No. Unlike the situation in health professions, there is no statutory regulation of standards or qualifications for working with Chinese herbs. This means that anyone could set up as a practitioner. A significant number of deaths occur each year after taking "Chinese" medicines. The golden rule is only to take the herbs exactly as prescribed for one dose and not to repeat the prescription without another consultation. The net results are often less satisfactory than reputation and expectation. Even in the flagship case of Chinese herbs working for eczema where efficacy has been proven by western standards, the treatment stopped working after a while. I would give this one a miss.

Yes. Many will have studied several years and passed exams like other health professionals. There is no single qualification. A reputable practitioner will have professional liability insurance. Those who do not should be avoided. The herbs most commonly used by herbalists are mild and not potent. Herbalists hold consultations like doctors and supply their own products to patients. The various initials you may come across are explained below.

Dip Phyt	Diploma in Phytotherapy
FNIMH	Fellow of the National Institute of Medical Herbalists
FRH	Fellow of the Register of Herbalists
IMH	Instiute of Medical Herbalists
MH	Master Herbalist
MNIMN	Member of the National Institute of Medical Herbalists
MRH	Member of the Register of Herbalists
NIMH	National Institute of Medical Herbalists
NMS	Natural Medicines Society

Certain herbs are popular for the treatment of ME eg Echinacea and Ginko Biloba. Products containing GLA such as Evening Primrose Oil, Starflower Oil and Flax seed may all help although, as with anything else, adverse reactions may be experienced by some people. Aloe Vera is a source of GLA but expensive.

Yes. Several products produced to patent formulas have been promoted to people with ME/CFS. These are multi-ingredient products sometimes described as herbal beverages. They are usually imported from outside the UK and are very expensive, priced at around œ20 per bottle. (Normal herbal products cost a couple of pounds.) They are often backed up by a money back guarantee. Many features appear in magazines written by people selling these products. Usually, these are people who say the product has helped them and by vending the product themselves they say they are helping others with ME/CFS.

Various benefits are reputed, but nothing has so far been proven to modern standards. These products contain in excess of ten ingredients. This was the practice in bygone days to protect a patent formula. The practice has long been abandoned by modern medicine because of product liability, incompatibilities between ingredients, or side effects. The products do not have a medicines act product licence, which means the merchants selling them have not tested them for efficacy and safety in use. They do not warn, for example, against taking the product in pregnancy.

I decided to make a safety assessment by listing the potential side effects of all the ingredients of several of these mixtures. If one of the ingredients can have side effects, then this must apply to the product as a whole. The net result of the exercise was a list long enough to make these products unusable by many people.

No. No person, not even a doctor, will guarantee that any product will work. Any medicine will only be effective in a certain proportion of cases. Medicines are sold for what they contain, not for what they are reputed to do.