A recent online article citing a warning from a cardiologist about the practice of self medicating with herbal medicine caught the attention of our team at the Institute for Natural Medicine and our partners at the American Association of Naturopathic Physicians. We recommend, don’t self medicate with herbal supplements. Instead see a naturopathic doctor who is trained in herbal medicine and encourage your physician to consult with a naturopathic doctor for professional advice.
In the article, a physician reports that her “20-something patients” are presenting heart arrhythmias, or irregular heartbeats, from taking herbal supplements like ephedra and bitter orange. Likely out of frustration, the cardiologist says there is a lack of literature to help inform them of the cause and efficacy and that formulations are poorly regulated.
As an organization that takes the tenor and tone of these types of articles very seriously, we would like to shed some light on what is known about botanical medicine and why it should be recommended by professionally trained licensed naturopathic physicians instead as a self-medication.
As for how they are regulated, herbal and other dietary supplements are regulated as a food as part of the Dietary Supplement Health and Education Act. It is illegal to manufacture or market a dietary supplement (vitamin, mineral or herb) that is adulterated or misbranded (i.e. the label must tell the user exactly what and how much of an ingredient is in the bottle). The FDA has the authority to remove all impure, adulterated and misbranded products from the market.
As for efficacy, there is a great deal of historical use and clinical-trial research on dietary supplements and botanical medicine. Though herbal products and other forms of dietary supplements are sold over-the-counter, as one would buy aspirin or a cough medication, there is a public perception that they can be taken without medical guidance. There could be adverse effects when any medication, herb or dietary supplement is used improperly and without guidance from a trained physician or pharmacist, as FDA outlines in their guidance.
The primary herbs cited in the mentioned article, bitter orange and ephedra, have a number of clinical uses, including healthy mental focus and cognition for bitter orange and respiratory support for ephedra. However, they are most often used in combination for individuals attempting to lose weight quickly and may be associated with negative cardiovascular effects when taken in higher levels than is recommended. There are at least 10 clinical studies looking at the side effects of bitter orange and ephedra. The researchers concluded that the products were likely not being taken as recommended.
Why you should not self medicate with herbal supplements
Botanical medicine is one of the most effective therapies a naturopathic doctor uses to gently and safely treat illness, while minimizing the risk of harmful side effects. However, our organization emphasizes that no one should take these or any herbal medicine or dietary supplements without the advice of a trained physician.
As is common when these stories emerge from the media, there is typically a call for more regulation and outright banishment of these products from the marketplace. We understand the concern among physicians and patients when these products are used without medical supervision, which is why we always recommend that patients see a licensed naturopathic doctor and that conventionally trained doctors work with naturopathic doctors to learn more about botanical and integrative medicine.
Naturopathic doctors have four years of training in accredited medical schools approved by the US Department of Education. That training includes both pharmaceutical and botanical-herbal medicine, so naturopathic doctors are well aware of contraindications and possible adverse effects of drugs, herbs and dietary supplements. Most conventionally trained physicians do not have the background to advise patients on the use of these bioactive ingredients, their side effects and how they could interact with pharmaceuticals.
Do not self-medicate, see a naturopathic doctor instead
The public often fails to realize that botanicals are medicine. Many of these ingredients are very-well researched precursors to prescription medications that we rely on today. Before any herb, dietary supplement or medication is prescribed by a licensed naturopathic doctor, the individual needs of the patient are assessed using what is called the Therapeutic Order. Herbal medicine is just one of the therapies used by naturopathic doctors for weight loss or any other health concern.
Most people seek out use of herbal medicine and dietary supplements because they are unhappy with conventional treatments, past positive experiences and opinions about herbal medicine, and a history of family traditions using such products. While we understand the frustrations associated with any aspect of healthcare, we caution against self-medicating with any herbal product, dietary supplement or over-the-counter medication.
The following is a quick list of everything one should consider before taking an herbal or dietary supplement without medical advice:
- Herbal and botanical supplements are plant-based medicines with clinical science supporting their efficacy, dosage and side effects. Even though they are made from plants, they are bioactive and have medicinal-health properties.
- Social media, online advertising and product marketing is not medical advice and should not be used to make medical decisions (even for weight loss).
- Understand there are limitations to any natural ingredient and it is not a replacement for seeing a licensed and experienced doctor.
- A licensed naturopathic doctor is knowledgeable about efficacy and adverse effects of the ingredients used in herbal medicine.
- If you want to adopt an integrative approach to your health, which means using conventional medicine and complementary forms of medicine, contact a naturopathic doctor instead of self-medicating.
- Always tell your physician about herbal medicines and dietary supplements that you are taking because they may interact with prescribed drugs or be contraindicated for your individual health status.
- If your physician discounts the use of herbal medicine, they may not have the training needed to give you the best advice.
- Get advice from licensed naturopathic doctors who are trained in conventional medicine for prescribed medications, as well as other complementary therapies, including herbal medicine, dietary supplements, nutrition, behavioral and lifestyle medicine and physical medicine. Please do not use the internet for dosage and product recommendations.
This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:
- Education – Reveal the unique benefits and outcomes of naturopathic medicine
- Access – Connect patients to licensed naturopathic doctors
- Research – Expand quality research of this complex and comprehensive system of medicine
Stewart is an award-winning editor, food and health journalist and best-selling author of Eating Between the Lines, the supermarket shopper's guide to the truth behind food labels (St. Martin's Press).
