You know to eat your vitamins, eat your fruits and veggies-but eat your ginkgo?
The rising popularity of herbal supplements in the United States is unmistakable: Joe Graedon, an expert on herbal medicine, said the proportion of people who use them has risen from 34 to 42 percent over the last decade. Americans visit alternative medicine practitioners 629 million times each year-more than the number of visits to primary care physicians. Additionally, they spend $27 billion on alternative treatments annually.
"There is a cultural mindset in the U.S. where everybody perceives natural is better, so the perception is that [herbs] have less side effect," said Dr. Larry Burk, associate professor of radiology and psychiatry.
Dr. Murali Doraiswamy, associate professor of psychiatry, attributed the popularity of herbal supplements to different factors. "Some of the surge is due to lack of access or dissatisfaction with current health care options and the chronicity of diseases," he explained. "Over-emphasis on technology and the conveyor-belt approach to medicine will encourage folks to seek alternatives."
Herbs are widely believed to help treat a number of conditions ranging from depression to the pesky, common cold. Ongoing research has also suggested they help improve cognitive performance, offer anxiety relief and provide cardiotonic remedies to heart failures.
Despite the popularity of herbal supplements though, researchers emphasize that there is still a lot that is unknown about them. For instance, it is often not clear which ingredients are active in these compounds, or by what mechanisms they work.
"It is crucial to understand the difference between the herbal approach, which involves ingesting the whole plant, versus the Western pharmacological approach, which is reducing a substance to its active ingredient," said Dagmar Ehling, a Chinese herbalist in Durham. "Western pharmacologists take a plant substance, find its active ingredient for treating a certain disease and extract it. The active ingredients are then concentrated, patented and sold as pharmaceuticals."
Although much has yet to be discovered, Duke scientists are at the forefront of herbal supplement research. In January, lead investigator Doraiswamy and his team published in the journal Public Health Nutrition the most comprehensive literature review of St. John's wort
Doraiswamy found that, among other things, taking St. John's wort is probably better for treating depression than receiving no treatment, but that "the jury is still out as far as how it compares to standard medical care with prescription treatments or psychotherapy."
However, Doraiswamy believes the public is poorly educated about the effects of herbs. "The list of drug interactions with St. John's wort seems to be growing almost daily, and so consumers should be aware that just because something is an herb does not mean it does not have side effects or interactions if taken inappropriately," he said.
Some herbalists are also concerned that the demand for herbal supplements may shift emphasis to researching and marketing a more potent, and more dangerous product. "Unfortunately, most herbal research that is currently being designed focuses on specific percentages of the active ingredients, which appears to miss the point of 'herbal research,'" said Ehling. "The minute one extracts an active ingredient from an herb it becomes a drug."
As a result, members of the medical profession are cautious about prescribing herbs. "Many physicians are skeptical about herbal approaches primarily because they have not been trained in their value," said Graedon who, with his wife Teresa, has published a number of books and on herbs. The couple also hosts a Saturday morning radio show on WUNC.
"Herbs were the only available therapeutic agents for thousands of years. They were the precursors to modern day medicines-even today doctors prescribe an amazing number of herbal products and don't even realize it," Graedon said.
But with the continuing rise of herbal supplement use comes a host of unanswered questions, and researchers are uncertain of appropriate legal regulation. "I think there should be regulation to ensure the quality [of a bottle's content], but I can only hope that [government officials] won't over-regulate and start pulling herbs off the market just because someone chose to quadruple the recommended dose and then blame the herb," said Ehling.
Burk sees herbal use becoming increasingly important in lifestyle changes, rather than being limited to just treating medical conditions. "Herbs can be better integrated into a holistic approach, not quite like drugs," he said. "People are beginning to understand the risk [of drugs] and there is a trend to go natural.... Research on them will be a hot area for years to come."
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