Last week The ABC’s 7.30 Report did a segment on the safety of herbal medicines. While the item was relatively balanced there were a couple of issues, that as a herbalist, I feel need to be covered.

Firstly, the trigger story for the segment was the Byard report published in the Journal of Forensic Sciences. While Byard is on staff at the University of Adelaide the study was undertaken in the USA, not Australia. The types of herbal products available in these two countries are not comparable as Australia has one of the most stringent therapeutic goods legislation in the world. Here all herbal products must be registered and evaluated for safety. Byard analyzed 251 Asian herbal products bought over the counter in the United States. Heavy metals including arsenic in 36 of them, mercury in 35 and lead in 24 of the products were identified. These herbal products mostly originated from Tibet, China and India. None were Western or made in Australia. Unfortunately herbal products made in Asia do not have a good track record and some are even deliberately adulterated with toxic or pharmaceutical substances.

As a Western herbalist it can be frustrating when journalists and medical researchers don’t understand the differences in our herbs and methods of preparation.

Summary – problems with the Byard report

• Australia has stringent legislation considering the manufacturing of herbal products and a complex registration process for all therapeutic goods.
• The US does not have any comparable safeguards for herbal medicines.
• No Australian products were analyzed in the study.
• No Western herbs were analyzed in the study.
• Chinese (TCM), Indian (Ayuvedic) and other Asian herb products unfortunately have a much greater risk of being deliberately or accidentally contaminated with heavy metals or pharmaceutical drugs.
• Western herbs do not have a history of deliberate contamination.
• If you think you would benefit from using herbal medicine see a qualified and experienced herbalist.
• Only buy over the counter complementary medicines with an Aust L or R number on the product.
• Do not buy herbs from overseas (mail order or internet).

Secondly, the program and its promos featured an Australian woman who suffered from liver failure, possibly from taking an over the counter product of a common North American herb, black cohosh (Cimicifuga racemosa). This is a herb widely used in the West for the symptoms of menopause. There has been a controversial, casual correlation between a small amount of women taking this herb, including some in Australia, with 3 women needing a liver transplant. However while all of the women supposedly took this herb in most of the cases worldwide the product itself has not been analyzed to make sure another (toxic) plant was misidentified and used instead. In the majority of cases of toxicity issues with Western herbs misidentification, substitution or incorrect dose have played a major role.

What the show didn’t cover was the substantial evidence that Maree Furler’s liver failure could have been caused by many other factors not mentioned in the program:

The patient had been a steady drinker, and had a history of obesity for which she had received a gastric bypass operation – all of which could have contributed to her liver failure. quote

I know of no qualified herbalist who claims that all natural products are safe. Herbs are powerful substances, they need to be identified correctly and used appropriately. Foods we eat every day can be harmful depending on the dose – theoretically you could ingest a large quantity of peanut butter that may cause liver damage (due to aflotoxins).

When there is an adverse reaction with a herb or natural product it goes straight to the headlines. The small handful of queried black cohosh related liver injuries often appear in the media, recycled years after the initial report which can be misleading as the number of cases affected. However common pharmaceutical drugs that kill or injure people do not receive the same amount of media attention. A common oral antifungal drug prescribed for athletes feet and ringworm (Lamisil) has caused more deaths due to liver failure than black cohosh but hasn’t grabbed nearly as many sensational headlines.

Regardless of whether it is a herb, nutrient or pharmaceutical drug you are ingesting the health of your liver is paramount in regards to risk factors. Anyone taking multiple medications, drinks alcohol or takes recreational drugs on a regular (daily or weekly basis), has a history of liver problems or is over the age of 55 is at a greater risk of complications.

Substantiating the risks associated with Black Cohosh are complicated. This medical article covers the issues well. I personally believe that black cohosh is a very effective medication for the symptoms of menopause but should be prescribed by a qualified herbalist using a credible source of the herb and the client monitored regularly for possible side effects. Almost every case that has queried black cohosh for liver toxicity has been self-prescribed and bought over the counter.

Summary – black cohosh

• There is some evidence of rare idiosyncratic reactions to black cohosh, though most cases sited have a casual rather than proven relationship with the herb.
• All women wishing to take black cohosh should do so under the care and regular monitoring of a qualified herbalist.
• There is strong evidence that the woman in question’s liver failure was caused by other factors.

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