Herb Labels Reflect the Lack of Industry Standards

Source: Tufts University
January 22, 2004

Herbal and botanical supplements are a multimillion dollar industry in the United States. But despite their popularity, many consumers are using them without telling their healthcare provider or asking their advice. Even those patients that do report what remedies they take may be unable to do so accurately because there is such inconsistency among products. Researchers from the University of Minnesota compared the variations in label information for ten commonly purchased herbs. Their findings are published in Archives of Internal Medicine.

The ten herbs most commonly purchased in the United States in 1998 identified by the researchers were Echinacea, St John's wort, Ginkgo biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian. For each of the ten herbs, all of the oral products available in selected stores were included. The investigators noted the information on the label such as ingredients, strength, recommended dose, and price. They compared the label information with the recommendations in the Professional's Handbook of Complementary and Alternative Medicines.¹ There are no established federal guidelines and the Handbook was chosen because it is one of the few academic publications that is not affiliated with a commercial manufacturer or distributor.

Many products, many recommendations

The number of products ranged from 42 for goldenseal to 143 brands and types of garlic. In all, they found a total of 880 products for just ten herbs. For each herb there was a wide variety of ingredients, dosage, and suggested uses listed on the labels. When compared to the standard reference the Professional's Handbook, there was also a wide range: less than half of the products were consistent with ingredients and dosage in that benchmark reference. The investigators looked for a 'marker of consistency' - brand name, price, or type of store - that consumers could use to identify products that were consistent with dosages in the Professional's Handbook. The type of store was not predictive, but for six of the ten herbs, a higher price was more likely to mean the label information matched that in the handbook. However, for the other four herbs (St John's wort, Ginkgo biloba, ginseng, and valerian), the opposite association was found: a lower priced product was more consistent with the benchmark guidelines.

The researchers concluded that even when patients inform their physicians about their use of an herbal supplement, neither can be fully aware of what is being ingested because of the variation in products and therefore, of label information. It's important to note that even though researchers relied on the Professional's Handbook of Complementary and Alternative Medicines as a standard, few comprehensive studies have been conducted on most herbs and information in the book is often derived from the few, small, and possibly not very rigorous studies which have been done. In addition, the researchers did not analyze whether the contents of the material in the bottle actually matched what the information on the label.

The more information, the better

The researchers recommend tighter control of the industry. In the meantime consumers should inform their healthcare providers of supplements they are using or considering using. To be precise, tell your physician what type and brand you are using - even bring in the bottle. Ask her or him for guidance, rather than relying on label information about uses and dosages.

Source

• Variation in product choices of frequently purchased herbs. J. Garrard, S. Harms, LE. Eberly,  et al., Arch Intern Med, 2003, vol. 163, pp. 2290--2295

Footnotes
1. Fetrow C, Avila JR, Margolis S. Professional's Handbook of Complementary & Alternative Medicines. Springhouse Pub Co (Short); 3rd edition (June 2003). To buy, click here

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