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Herbal Products: Balancing the Good and Bad

We've all seen the ads for "natural" products that can help you lose weight fast or help suppress appetite. But, do any of these really work? It's a real gamble because there are no standards for these products; the manufacturer doesn't have to prove that the product is safe or effective or even that the product contains the ingredients listed on the label.

To help remedy this problem, Congress recently created the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), Bethesda, MD. Currently researchers at the Center are studying some herbs that have been helpful for some persons, including St. John's Wort (used for depression), gingko biloba (energy and memory), saw palmetto (prostate health), and glucosamine/chondroitin (bones and joints).

Several herbal products of particular interest for persons with eating disorders are found in products that claim to aid weight loss, as well as appetite suppressants and laxatives.

Herbs for Weight Loss

So far the only herbs that have shown any promise as weight-loss drugs are ephedrine and caffeine. These are marketed as a combination of ephedrine and caffeine or as the herbal sources, which include the drug ma huang (ephedrine) and a source of caffeine such as guarana seed or kola nut. However, even if they result in slight weight loss, there are substantial risks. The big problem is that the botanical sources may contain too much or too little of either ingredient; there is no way to know since there are no standards for this.

Caffeine and Ephedra-What's the Harm?
Caffeine, which is found in varying doses in beverages and medications, can cause insomnia and tremors, and acts as a diuretic. It is the most widely used "drug" in the world, thanks to tea and coffee lovers. By itself, caffeine isn't harmful for most people. However, when caffeine is teamed with ephedrine, it can speed up the heart (tachycardia), and cases of heart attacks and stroke have been reported. Other side effects include acute hepatitis, headache, tremor, nervousness, and insomnia.

Ephedra (Ma Huang): One to Avoid
The Chinese have used ephedra for more than 5,000 years. An extract of this powerful herb is ephedrine, one of the most effective treatments known for asthma, allergies, and sinus problems. Ephedra is a central nervous system stimulator that can increase pulse rate and blood pressure. Reputable manufacturers will include a warning about this on the label.

The main problem with ma huang is that many herbal manufacturers spike their ephedra-containing weight loss products with caffeine, usually by adding herbs such as guarana seed or kola nut. By itself caffeine can raise blood pressure and cause heart palpitations. When it is teamed with ephedra, the effects are magnified.
We strongly recommend that you not use ephedra-containing products.
However, if you do, please note the following:
1. Don't use ephedra products that also contain caffeine; this includes those that contain guarana and cola (or kola) nuts. 2. Choose an ephedra product that uses the whole herb, not just the extracted ingredient ephedrine.
3. Reduce the amount as soon as any side effects occur and stop the drug immediately if any of the following symptoms occur: headache, nervousness, sleeplessness, anxiety, nausea, and urinary problems.

Yohimbine: No Proven Benefits
Yohimbine is made from the bark of a West African evergreen tree and was originally used as an aphrodisiac and stimulant for warriors preparing for battle. Some appetite suppressants contain yohimbine. Promoters also claim that it helps decrease body fat. Potential side effects include anxiety, elevated blood pressure, a feeling of queasiness, insomnia, rapid heartbeat, tremors and vomiting. The FDA has declared yohimbine unsafe and ineffective as an over-the-counter drug.

Laxatives: Dulling Down the GI Tract
First, and most importantly, laxatives do not really cause the loss of significant amounts of food or help in weight loss. They do cause dehydration and reflex fluid retention. Therefore, laxative use is an ineffective weight-control technique and can be dangerous.

A number of these herbs contain ingredients that act by irritating the lining of the intestines or by directly stimulating the nerves; over time and with overstimulation, the bowel becomes nonresponsive. Laxatives often contain stimulants such as bisacodyl, cascara sagrada, or senna. Bisacodyl can lead to stomach irritation, cramping, and loss of fluids and electrolytes. Cascara sagrada can cause severe vomiting, electrolyte imbalance when abused, and loss of potassium which can make certain diuretics more toxic. Finally, senna can cause abdominal cramps, nausea, increase mucus secretion, and eventually help lead to reduced bowel function.

What Can You Do?

If you buy herbs, how can you tell which have the highest quality and which products really contain what the label claims? There is no guarantee that the ingredients listed will match the actual contents, so remember that contamination, mislabeling, and misidentification can be a problem.

Experts at the Mayo Clinic offer 5 tips for choosing the best brands of herbs:
1. Look for herbal extracts that are standardized. The USP (United States Pharmacopoeia) or NF (National Formulary) mark on the label or package is a clear sign that the manufacturer is following USP standards.
2. Choose a brand that adheres to higher manufacturing standards than are required. All herbal product manufacturers are supposed to follow standards established for processing foods; these are known as Good Manufacturing Practices (GMPs). Some companies set even higher standards for themselves, and usually will advertise this fact. Look for it in their ads.
3. Buy only single-herb products that clearly show how much is in each dose.
4. Beware of claims that sound too good to be true. Use your own common sense. No single herbal product can possibly take care of a wide number of claims.
5. The FDA advises avoiding 5 dangerous herbs: belladonna, comfrey, broom, lobelia, and pennyroyal.

What To Do If You Have a Bad Reaction to a Herbal Product

If you become ill from taking an herbal remedy, call your doctor. You or your doctor should also report the problem to the FDA. Call 800-FDA-1088 (800-332-1088) or go to the FDA's MedWatch Web site: www.fda.gov/medwatch.

When you call, they will ask for certain information:
a. The name, address, and telephone number of the person who became ill.
b. The name and address of your doctor or hospital where you were treated.
c. A description of the problem.
d. The name of the herbal product and the store where you bought it.

It is also a good idea to contact the manufacturer or distributor listed on the product label, as well as the store where you bought the product; if possible include the lot number listed on the bottle or box.

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Recognizing and Responding to Binge Eating in Children
Regaining Weight in a Healthy Way
Revising the Diagnosis of Anorexia Nervosa Will Improve Patient Care
Saving Your Teeth: First, Reconsider When to Brush
Serotonin: Implications for the Etiology & Treatment of Eating Disorders