What to Know About Taking Herbal Supplements

Herbal supplements have been around for thousands of years, but their lack of regulation in the U.S. can make them dangerous to consumers.

September 30, 2022

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Photo by: Chris Rogers/Getty Images

Chris Rogers/Getty Images

Herbal supplements are classified as food supplement products without a prescription containing one or more herbal ingredient. They come in many forms including pills, powders, tinctures, and teas and are sold at most major retailers and online vendors — and even gas stations! Sales of herbal supplements exceeded $8 billion in 2018 and the industry shows no signs of slowing down. According to data published in 2022, half of the US population uses herbal products, believing that they are a safer or less harmful alternative to medications. The truth is some of the most popular herbal supplement products can be the most dangerous.

Are Herbal Supplements Regulated?

Like other dietary supplements, herbal supplements are poorly regulated by the Food and Drug Administration (FDA). Herbal supplements are not required to receive pre-market approval and are not subject to the FDA processes in place for over-the-counter (OTC) and prescription medications, which help ensure safety and efficacy through clinical research studies and post-market safety monitoring. This mean the herbal products on the market do not have to be tested for safety, efficacy or label accuracy. In many instances this lack of comprehensive oversight has lead to the sale and distribution of dangerous, contaminated and improperly-dosed products. Common dangers associated with supplements include stomach upset, cardiovascular problems, liver damage, increased risk of cancer, nerve damage, kidney problems and possibly death.

What Are the Side Effects?

Several commonly used herbal supplements have risks of side effects and can interact with other supplements as well as OTC and prescriptions medications.

Ginseng: The antioxidant compounds in ginseng, a popular adaptogen, are known as ginsenosides, which may be involved in controlling stress hormones. This herb shows promise with persistent stress and chronic inflammation, but should only be used under the supervision of a medical professional. The National Center for Complementary and Integrative Health cautions taking ginseng when on medications like blood thinners, sugar-lowering drugs, and blood pressure-reducing drugs.

St. John’s Wort: This herb is taken for various conditions including depression, anxiety, menopause and attention-deficit disorders. There’s some scientific evidence to support that it may help treat the symptoms of depression, but large doses (2 to 4 grams per day) can cause severe skin reactions due to an increased sensitivity to sunlight. Other possible side effects include insomnia, anxiety, irritability, stomach upset and dizziness. It’s also been found to negatively interact with OTC non-steroidal anti-inflammatories (NSAIDS), birth control medications, and blood thinners.

Gingko: Most commonly taken for improved memory and brain function, gingko leaf extracts are the most popular form of this herb. Seeds of the gingko plant can be dangerously toxic and potentially deadly. Despite a very small amount of outdated research, gingko doesn’t appear to improve memory in people with normal mental function, nor does it reduce the risk of developing memory related problems. Side effects include increased bleeding, stomach upset, headache dizziness and heart palpitations. Pregnant women are urged not to take gingko because of its possible labor-inducing effects. Gingko has also been found to interact with chemotherapy, diuretics, anticonvulsants and diabetic medications.

Bitter Orange: This herb may not sound familiar, but it can be found in many popular weight loss supplements. While this fruity-named herb may sound safe, it was placed on the 2010 Consumer Reports List of Supplements to Avoid because of a list of possible dangers including fainting, heart problems, stroke and death. This herb becomes increasingly unsafe when combined with caffeine – another popular ingredient in weight loss products.

Even if interactions with other substances are not a concern, these herbal products can also cause side effects independently. Ginkgo usage can cause stomach upset, dizziness and skin reactions, while St. John’s wort side effects include insomnia, fatigue, dizziness and sexual dysfunction. Guarana, a popular stimulant found in energy drinks, has been linked to stomach upset and dangerous increases in heart rate and blood pressure.

What to Do If You Want to Try Herbal Supplements

If you are taking or considering taking an herbal supplement, do your homework and discuss it with your medical provider. One of the best resources for accessible information on popular herbal supplements in the National Institute of Health (NIH) “Herbs at A Glance” from the National Center for Complimentary and Integrative Health. Click on the herb you are interested in and access a detailed explanation of uses, research studies (if any have been conducted) and a list of potential side-effects, interactions and other dangers.

Consumer Reports also publishes list of 15 Supplement Ingredients to Avoid, highlighting several herbal ingredients and their potential risks to health.

Bottom Line: Discuss any herbal supplements with a registered dietitian nutritionist (RDN) or other qualified medical professional before taking them. Be sure to disclose all supplement use with medical providers to reduce the risk of harmful interactions.

Dana Angelo White, MS, RD, ATC, is a registered dietitian, certified athletic trainer and owner of Dana White Nutrition, which specializes in culinary and sports nutrition.

*This article was written and/or reviewed by an independent registered dietitian nutritionist.

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