We Americans now
spend an estimated $20 billion a year on dietary
supplements and so-called “natural” remedies, many
of us blissfully -– even willfully -– ignorant of
the actual medicinal value, or utter lack thereof,
in of these products.
It’s not entirely our
fault that we buy this stuff so blindly. In 1994,
Congress limited the power of the US Food and Drug
Administration to regulate supplements and herbal
medicines, which now are allowed to get -- and stay
-– on the market unless clear evidence of harm is
found.
We’ve been left
largely to our own devices to figure out which
alternative remedies actually work, and are safe,
and which are pure snake oil.
Happily, a few
reasonably trustworthy websites have sprung up
allowing consumers to evaluate how much credible
research there is (or isn’t) for a particular
supplement, how the “natural” remedy in question
interacts with other such products or with
prescription drugs, and what the major side effects
are.
(I put “natural” in
quotes, by the way, because the term is meaningless
for health products. Pills from health food stores
are not intrinsically safe, gentle or non-toxic just
because they are called “natural.” And they’re much
less likely than prescription drugs to even contain
the ingredients listed on the labels.)
To facilitate
comparisons among my favorite sites, I’ve tracked
how they rate three of the top-selling products:
black cohosh, often used to treat hot flashes;
Echinacea, used to treat and prevent colds; and the
combination of glucosamine-chondroitin, used to ease
the pain of osteoarthritis. In truth, it’s hard to
tell how solid the science is for these, and many
other, alternative remedies, but some sites do a
better job than others at pointing out the products’
shortcomings. Some information on these sites is
free, but for details, you often have to pay
(typically $15 to $50) per year.
For starters, I
recommend the site run by the National Center for
Complementary and Alternative Medicine (part of the
National Institutes of Health). It is quite helpful
and easy to use. To check on echinacea, for
instance, go to
http://nccam.nih.gov/health/echinacea. The
information is succinct, noting that studies show
echinacea does not appear to prevent colds or other
infections, nor does it shorten the lengths of colds
or flu.
For black cohosh, the
site says studies are mixed for menopausal relief
and notes that it has been linked with liver
problems, though the site cautions that it’s not
clear if black cohosh is truly to blame. As for
glucosamine-chondroitin, the site includes the GAIT
study results showing the remedy did not provide
significant relief for osteoarthritis patients,
except for a small subset of people.
Another of my
favorite sites, because it is the most aggressively
critical, is
www.worstpills.org the creation of Public
Citizen’s Health Research Group in Washington, D.C.,
which takes no money from government or industry and
relies on membership fees and product sales. The
site is very thorough and put all three of my test
supplements in the “Do Not Use” category.
Worstpills.org
concludes, for instance, that “there is no
significant evidence that black cohosh alleviates
menopausal symptoms.” Among adverse effects, it
cites two cases in the medical literature of liver
transplants possibly linked to the supplement.
As for echinacea, the
site concludes that there is “no convincing
evidence” that it reduces the frequency or severity
of the common cold.
On
glucosamine-chondroitin,
www.worstpills.org includes information from
the most recent and most credible study (the
so-called GAIT trial, published in February, 2006 in
the New England Journal of Medicine) which found a
non-commercial form of the combination ineffective
except for a subgroup of people with
moderate-to-severe pain.
Another good site is
www.herbalgram.org (click on "herbal
information"), run by the Texas-based American
Botanical Council and its chief guru, Mark
Blumenthal. The council gets half its funding from
the supplement/herbal industry, and the other half
from health professionals and researchers. Despite
its industry backing, I find the site thorough,
accurate and fairly independent.
On black cohosh,
herbalgram.org put out a special article in March
after an Australian government agency warned the
substance was linked to liver toxicity. The site
goes deep on black cohosh and notes that a leading
black cohosh product, Remifemin, now carries a
warning label about potential liver toxicity.
On echinacea,
herbalgram.org has so much material it’s tough to
find a bottom line. It acknowledges the lack of
efficacy for treating or preventing colds, but
points out that the most recent clinical trial was
done with doses that were too low to be effective,
Blumenthal said. The group did not evaluate
glucosamine-chondroitin because it is not an herbal
product.
Consumer Reports is
another good site. A few weeks ago, the group added
a rating system for “natural” remedies to its
website --
www.consumerreports.org/mg/natural-medicine/ratings.htm.
The massive amount of information in these ratings
of 14,000 herbs, vitamins and nutritional
supplements comes directly from a respected source
used by pharmacists and physicians, the Natural
Medicines Comprehensive database, which gets no
industry funding and is supported only by
subscriptions from physicians and pharmacists.
The Consumer Reports
site provides a huge amount of detail about each
product and possible interactions with other
medications. Despite its vastness, it’s easy to use.
It goes easy on black cohosh, calling it “possibly
effective” for hot flashes, though it does note
possible interactions with drugs like cisplatin, the
cancer drug. A “possibly effective” rating means
there is some evidence of efficacy and possibly some
negative evidence.
The site is also kind
to Echinacea and glucosamine-chondroitin, calling
them both “possibly effective.” Echinacea, said the
database editor, Dr. Phil Gregory in an e-mail, is
not effective at all in preventing colds, and is
only possibly effective in treating an existing
cold. On glucosamine-chondroitin, he said that
although the GAIT trial looked at the combination,
most research uses glucosamine sulfate alone and
that does appear to be effective.
One other government
site rates a mention. It’s run by the FDA, and lists
dietary supplements the agency has issued safety
alerts for (
http://www.cfsan.fda.gov/~dms/ds-warn.html) It
has issued no such alerts for black cohosh,
echinacea or glucosamine-chondroitin.
My take on all this
is that there are probably some useful, safe
supplements out there.
But the whole field
of dietary and herbal supplements is basically
faith-based medicine, so I’m glad there are some
websites to check with to make sure while I think
I'm doing myself some good, I'm not accidentallly
doing harm.
Judy Foreman’s column runs every other week. Past
columns are available on
www.myhealthsense.com. Listen to her live
call-in webcast radio show every Wednesday night
from 8:30 to 9:30 EST on
http://www.healthtalk.com.
Note: the picture
is courtesy of
Jack Gallagher Ueland Illustration Co.
www.uelandillustration.com
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