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The effectiveness of herbal supplements is a frequent subject of discussion in medical journals. Recent coverage of the relationship between the use of herbal supplements and heart health, however, misrepresents the quality and safety of natural health products (NHPs) in Canada.
The article, “Use of Herbal Products and Potential Interactions in Patients With Cardiovascular Diseases,” appeared earlier this week in the Journal of the American College of Cardiology and is a biased attack on herbal supplements. It gives readers the impression that herbal supplements are unregulated and consumers are “unprotected” from “untoward effects.”
Such alarmist claims in no way reflect the state of NHPs in Canada. Herbal supplements offer numerous health benefits. Like any NHP, however, they can interact — both in support and antagonistically — with medications. Manufacturers must obtain a product license before selling a supplement. Any product carrying a Natural Product Number (NPN) has been assessed for quality, safety and efficacy by Health Canada. The absence of an NPN means that Health Canada cannot provide such assurances.
Health Canada also requires that product labels list recommended conditions of use (such as purpose, dosage form, route of administration and dose) and any cautionary statements, warnings, contra-indications and possible adverse reactions associated with the product.
As a responsible manufacturer, Jamieson Laboratories also advises each customer to speak openly with his or her doctor about NHPs during a medical history and prior to use.
In addition to abiding by labeling regulations, NHP manufacturers must report adverse reactions to Health Canada. This information is an important part of Canada’s product authorization system based on risk assessment and risk management. The results are published in the Canadian Medical Association Journal, which reaches 67,000 physicians, and a hard copy of the document is distributed to 26,000 pharmacists every year.
Statistically in the United States, for example, nearly one in four adults uses herbal supplements. During the first full year of adverse-reaction reporting in that country, the Food and Drug Administration received only 672 reports of serious events for all dietary supplements. During the same period, there were more than 300,000 reports of serious events from drugs or medications and nearly 50,000 deaths. The authors appear misinformed about the facts and safety protocols regulating NHPs — even in their own backyard — and their conclusions are unnecessarily alarmist.
What Species Is That?
The absence of specifics in the article is a disservice to readers. The authors do not identify herbs by their botanical names, but make sweeping claims about the effects of herbal products. Individual herbal ingredients act uniquely and the omission of botanical names makes it impossible to accurately identify documented effects.
Not in My Medicine Cabinet
The article’s product tables also list numerous “commonly used herbs” that are, in fact, neither licensed nor used in regulated North American supplements:
• oleander (Nerium oleander): a well-known toxic herb containing cardio-active glycosides
• chan su: dried Chinese toad venom, which is neither a herb nor generally used as a dietary supplement
• grapefruit juice: well known for increasing serum levels of pharmaceuticals, but not a herb
• ginseng: some species have pharmacological effects, but the authors fail to identify the species in their study and repeat erroneous findings from a widely discredited 1979 study.
Herbal supplements do not replace medications or the need for intelligent lifestyle choices, such as a healthy diet or regular exercise. Instead, natural health products can be part of a comprehensive health regimen. When consumers buy products from reputable companies, they can be confident that the products have been assessed for safety, quality and health claims.
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