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Highlighting the Hazards of Herbal Remedies

A new medical journal report highlights the potential dangers of herbal supplements.

An estimated 40 million Americans take herbal supplements assuming that they are safe and effective. They often are, but a new journal article highlights the very real dangers of herbal remedies.

In their new article "Global hazards of herbal remedies: Lessons from Aristolochia," published this month in "EMBO Reports" Arthur Grollman and Donald Marcus note that "the history of herbal use shows that not all herbs are benign and sometimes are deadly. Moreover, we cannot know whether all herbal medicines are safe because only a few have been tested systematically for toxicity or carcinogenicity."

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The authors highlight a widely-used herb called Aristolochia, also known as birthwort or pipevine. Various species of the herb are used in alternative and Chinese medicines, where it is claimed to treat edema and arthritis and used as a disinfectant. As Grollman and Marcus note, "The recognition of Aristolochia's profound toxicity and carcinogenicity in humans began in the early 1990s, when about 100 otherwise healthy Belgian women developed a rapidly progressing chronic kidney disease that ultimately required dialysis or renal transplantation."

If the plant can be toxic, why weren't the health dangers known earlier? As an article on "Science Daily" notes, "Almost all carcinogens and many toxins require a long period of time before symptoms appear. This makes it very difficult for a layman or a professional to identify a particular compound as the cause of an illness when it was taken months or years earlier."

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Though most people think of poisoning as being a sudden event (such as by an accidental ingestion or single serving of contaminated food), people can unknowingly poison themselves over the course of several years. Residents of Flint, Mich., for example, drank lead-poisoned water for years without being aware of the problem. Similarly, a person may unknowingly consume small doses of a toxic-but seemingly harmless or even beneficial-herb that builds up in the body and causes disease months or years later.

Herbal supplements are not regulated by the Food and Drug Administration because they are not marketed as drugs. According to the Dietary Supplement Health and Education Act of 1994 herbal supplement manufacturers are entirely responsible for ensuring the safety and effectiveness of their products. Health officials typically only intervene when illnesses or deaths are reported, and of course by then the damage has been done.

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An investigation into the herbal supplement industry led by the New York Attorney General discovered that four out of five bottles of herbal pills sold in national drugstore chains didn't in fact contain any of the herbs indicated on their labels. In other cases they existed in dosages so small as to be ineffective, and were often diluted with cheap filler including powdered rice.

Many people think of herbs as being harmless, assuming that "natural" means "healthy," though that is not necessarily the case. Grollman and Marcus note in their article that they are not arguing against the use of traditional healing practices in general, but instead raising awareness of the potential harms and to "encourage the global health community to take actions that will evaluate both long- and short-term safety, as well as the efficacy of botanical products in widespread use." While many herbs are beneficial (or at least not harmful), others may interfere with the effectiveness of prescription drugs, so patients should always tell their doctors about all medicines and herbal supplements they are taking.

There's a very good chance that some of the medicine in your home contains an animal-derived ingredient. The most frequently included animal-based ingredients in meds, according to a new study in the British Medical Journal, are lactose (often extracted from curdled cow’s milk), gelatin (frequently sourced from cows) and magnesium stearate, which can also come from a cow and is a magnesium salt containing stearic acid. A PETA fact sheet mentions that stearic acid additionally can come from dogs and cats euthanized in animal shelters, but cows remain the primary source. “Lactose, the most common ingredient we found in medications, was largely made using the lining of young cow stomachs as part of the manufacturing process,” BMJ study co-author Kinesh Patel told Discovery News. Patel is a research fellow at St. Mark’s Hospital’s Wolfson Unit for Endoscopy in the U.K.

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Both magnesium stearate and gelatin, along with a blood clot preventer called heparin, can come from pigs. Patel and co-author Kate Tatham told Discovery News that the top 10 common medicines most likely to contain ingredients derived from animals are: aspirin, simvastatin, paracetamol, thyroxine, omeprazole, lansoprazole, salbutamol, ramipril, amlodipine and atorvastatin. Aside from aspirin, most of these are sold under snazzier brand names, so if you are curious or concerned about animal-based ingredients, be sure to read labels carefully and research drugs via the manufacturer’s website and other provided information.

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Estrogen is sometimes sourced from female hormones derived from pregnant mares’ urine, according to PETA. Horses and other animals are not killed for drug manufacturing, though, according to Patel. He said the ingredients are “likely to be from leftovers” of butchering for other purposes. In the United States, this likely means animals found in meat markets, such as cows and pigs. But in Central Asia, for example, horse meat is considered to be acceptable.

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Gelatin in drugs can come from fish, the researchers share. They add that many patients are unaware that commonly prescribed drugs often contain animal ingredients. “Our data suggest that it is likely that patients are unwittingly ingesting medications containing animal products with neither prescriber nor dispenser aware,” Patel and Tatham wrote. They call for improved drug labeling, mirroring the standards advised for food.

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Chitosan, a binder in some ointments, is derived from shellfish shells. It helps to bind lipids, or fats, in medicines and other products, such as hair-care items and antiperspirants. Although the level of this and other possible animal products in many medications is likely to be minimal, Patel and Tatham say doctors need to consider this when prescribing "to avoid non-adherence, which is a major healthcare concern." Adherence, in this case, means that doctors should be forthright about what’s contained in medications.

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A red pigment known as carmine or carminic acid can come from an insect called the cochineal (and the pigment is sometimes called cochineal). According to a report on Foodnet, the pharmaceutical industry uses cochineal to color pills and ointments. There are conflicting studies as to how such ingredients -- in very small amounts -- might affect human health.  A study conducted by J.B. Greig of the Food Standards Agency in London found that cochineal could be linked to asthma. Patel and Tatham, however, told Discovery News: “There are no specific health concerns associated with the ingestion of any of these (animal and insect derived) ingredients.”

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Some ointments contain ingredients derived from egg protein. These, and other ingredients, usually can be substituted with compounds from other sources. “The medicines we investigated could largely be made without animal-derived products,” Patel said. He added that the more commonly used gelatin and magnesium stearate inclusions now have vegetarian counterparts.

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The oil glands of sheep produce lanolin, found in many medicines and ointments. Those who are vegan or vegetarian try to avoid use of such animal products. The researchers further point out that religion, culture, economic status, environmental concerns, food intolerances and personal preferences also can influence whether a person wishes to consume an animal-derived ingredient.

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The enzyme lipase can be derived from juvenile sheep, aka lambs. Lipase is in some medicines treating digestion problems. PETA mentions that the enzyme can come “from the stomachs and tongue glands of calves, kids and lambs.”

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Shark liver oil, squalene, is in some vaccines and over-the-counter products, such as glucosamine (chondrontin). “Many of the companies are multinationals,” Patel said. Shark-based ingredients are thought to largely come from Asia, where a shark slaughterhouse was recently found in southeastern China. The organization WildLifeRisk found that the factory processes approximately 600 whale sharks and basking sharks each year.

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