UK herbal remedy ingredient check by UCL School of Pharmacy: Many poor quality products, though those with the THR label fare better

[AussieNeil]

Do herbal supplements contain what they say on the label?

bbc.co.uk/programmes/articl...

This research, recently reported by the BBC, is not a new problem or just restricted to the UK. It's in part because herbal remedies are regulated as food supplements, even though they are sold on the basis of providing a medicinal benefit, that is "having curative or palliative properties". Similar studies in the USA, Australia and Canada report similar quality problems.

Some extracts from the BBC report, which is worth reading in full;

Dr Chris van Tulleken joined forces with Professor Michael Heinrich and Dr Anthony Booker from the University College London (UCL) School of Pharmacy to test a range of the herbal products on sale in the UK and reveal the shocking truth about what’s really in them.

Herbal products are available in various forms on the UK market.

Firstly, they can be sold as ‘traditional herbal medicines’. In the UK the traditional herbal registration (THR) scheme which is overseen by Medicines and Healthcare products Regulatory Agency (MHRA) provides a framework whereby manufacturers of good quality herbal products can register these as medicines based on ‘a tradition of use’. This means that a herbal product has been used traditionally for at least 30 years (15 years ‘non-EU’ and 15 years in the EU, or more than 30 years in the EU).

This not only allows the manufacturer to make a restricted medicinal claim on the packaging (e.g. ‘A traditional herbal medicinal product used to relieve the symptoms of slightly low mood and mild anxiety exclusively based on tradition of use only’), but importantly, the THR means the herbal product has been assessed by various scientifically qualified individuals and that the company complies with certain good manufacturing specifications. Overall, this means that while the evidence for efficacy may be limited, the scheme provides an assurance that you are getting not only a good quality product, but also more reliable advice on how to use it.

The regulations surrounding herbal medicinal products have, however, been interpreted in a variety of ways, and consequently there are a large group of products which remain unlicensed and unregulated. These products are classified as ‘food supplements’. By contrast with the THR products, these products cannot make any specific health claims, however people may still buy them expecting certain therapeutic effects. Their quality requirements are generally based on food legislation, which means that these products are not subject to anything like the same level of legal and manufacturing scrutiny as a THR product.

However, the food supplements showed a wide range of quality.

Of the food supplement products labelled as Ginkgo that were tested, 8 out of 30 (27%) contained little or no ginkgo extract.

36% of the food supplement milk thistle products contained no detectable milk thistle

:

However, all of the evening primrose food products we tested did contain what the packet claimed.

:

The research team at UCL believe that the wrong plant material is frequently used to manufacture herbal supplements. The use of cheaper or more readily available ingredients in the manufacture of herbal supplements may be widespread for a number of reasons: suppliers may unknowingly collect the wrong material, or suppliers may knowingly provide manufacturers with cheaper substitutes, or in some cases the manufacturers may be deliberately using cheaper materials to make their product.

Eight years ago, similar problems were found in the USA;

NY Attorney General accuses major retailers of selling contaminated, substituted and falsely labelled herbal supplements

On the basis of DNA barcoding technology tests conducted on top-selling store brands of herbal supplements at four national retailers in New York State — GNC, Target, Walgreens and Walmart, the New York State attorney general’s office has demanded that the retailers remove the products from their shelves. Details along with copies of the four, 4 page cease and desist letters to the above companies from the New York State attorney general’s office, stating what was and wasn't found in top selling Gingko Biloba, St John's Wort, Ginseng, Garlic, Echinacea and Saw Palmetto herbal supplements.

healthunlocked.com/cllsuppo...

The BBC report prompted this response from Professor Ezard Ernst, who established the world’s first Chair in complementary medicine at the University of Exeter, UK in 1993.

UK herbal remedies: many poor quality products and much poor quality advice

edzardernst.com/2023/05/uk-... where he concluded;

This is an interesting investigation. The researchers should be commended for it! However, I disagree with some of their conclusions. Here is why:

- The investigation merely tested the quality of the products and NOT THEIR SAFETY! To claim that the THR ensures access to safe herbal medicines is incorrect. A product might be of adequate quality but can still be unsafe. The THR only implies safety because the herbal has been used for years without problems being noted. This is not the same as ensuring that it is safe. A direct test of safety is usually not available.

- The recommendation to buy a product with a THR mark is also somewhat misleading. It implies that these products are effective. I fail to see convincing evidence that either MILK THISTLE, GINKGO, or EVENING PRIMROSE are effective for any disease or condition. Thus the responsible recommendation should, in my view, be to NOT buy them regardless of whether they are of good quality or not.

Not mentioned, but which can be extremely important to us, are potential interactions between the active ingredients (if they are present! ) and prescribed treatment drugs.

Drugs.com is one site which provides an interactions checker; drugs.com/drug_interactions...

Memorial Sloan Kettering Cancer Center's About Herbs, Botanicals & Other Products, provides a viewpoint from the opposite perspective; how herbal supplements may interact under the Herb-Drug Interactions section, though the Contraindications and Adverse Reactions sections are also well worth reading.

mskcc.org/cancer-care/diagn...

Neil

[spi3]

Thank you Neil - I am so hesitant to introduce/share alternative treatments to my hubby because of the possibility of negative interactions with his CLL treatments. At times I feel I want to do so much more for him and then I remember I can pray and be still.

[JigFettler Volunteer]

I urge everyone to read this post.

The importance of what your post communicates, Neil, can't be over stated.

I met Prof Ernst a few times, heard hom lecture. RCT and evidence provenance has to be at the core of therapy evaluation.

Illness is big business, stay safe.

Jig

[LeoPa]

I think that if we applied the same strict criteria to all food items currently on the market the majority of them would be withdrawn. Wrong food choices can mess with good health exactly as much if not more than inefficient supplements which are a waste of money most of the time.

[flipperj in reply to LeoPa]

There will always be a war of synthetic chemicals vs nature. Accurately testing the composition of natural substances is an extremely difficult task due to complex matrix effects. The test method, including sample prep/ extraction needs to be validated specific to each product. This is rarely done hence these articles showcasing wildly varying results. I’m more concerned about pesticides in my produce and all the folks dying from drug exposure than an ineffective supplement. ethics.harvard.edu/blog/new....

[LeoPa in reply to flipperj]

Agreed. Plus, it's not only synthetic pesticides that I'm worried about. ncbi.nlm.nih.gov/pmc/articl...

A pesticide is a pesticide no matter where it comes from. Natural or synthetic.

Sure they are supposed to kill bugs and not harm humans. But is that so? It's anybody's guess.

We know that DDT and atrazine usage was a bad idea.

quizlet.com/explanations/qu...

So, how many of the ones currently in use will later proven to be harmful?

I wish I knew.

[flipperj in reply to LeoPa]

There are lots of things in nature that want to hurt us. Plants develop defense mechanisms to avoid predation etc. The Agro industry has some similarities to Pharma in that compounds are often taken from nature, tweaked to enable patent protection, and marketed as discrete entities. The difference with Pharma is there is a wholesale campaign to discourage folks from the pursuit of fundamental approaches to health and wellness as this competes with the need for chemical interventions. After having spent much of my career developing and validating test methodology, and inspecting drug and supplement companies, it's hard not to see articles like the BBC one referenced as useless propaganda. The HPTLC testing referred to in the article is quite rudimentary and not the standard for ensuring the content and quality of products released to market. I would never rely on this testing to make any judgement on what I consume.

[2016Longevity in reply to flipperj]

please give me some examples of these Pharma wholesale campaigns ( to discourage folks from the pursuit of fundamental approaches to health and wellness ). thanks in advance !

[flipperj in reply to 2016Longevity]

It's evidenced every time we see our healthcare providers with common lifestyle afflictions such such high blood pressure, high blood sugar, inflammatory syndromes etc., and we leave with a prescription instead taking the time to diagnose and correct the underlying issue that brought us there in the first place. In my area, the pharma industry has a hand in our institutions for learning, regulatory policies, payor reimbursement policies and subsequently the types of care we have access to, marketing influences etc.

[2016Longevity in reply to flipperj]

well, at least plenty of people are still employed

[LeoPa in reply to 2016Longevity]

Not enough of them looks like. Anybody here got only a few minutes with his doctor at best, walking away with a prescription feeling like he did not get the attention that his condition deserves to? Not to mention telehealth and not being able to see a doctor in person for extended periods of time? Everybody is so sick, and that on a mass scale, that if every second person was a traditional health care provider MD, they would still not be able to keep prescribing drugs fast enough. Anybody wondering about why we got to this point in the last what 50 to 70 years? I do.

[AussieNeil Partner Administrator in reply to flipperj]

That's thankfully become increasingly controlled by regulation. Gone are the days, at least in Australia, where it was common to see your doctor's office and desk littered with pharmaceutical company provided clocks, calendars, pens, notepads and other nicknacks promoting their drugs.

Don't ignore the similar promotion of herbal remedies. In Australia, significant space is given to their promotion in supermarket and pharmacy advertising catalogues. Supermarkets even produce "Health and Beauty" catalogues of which over 50% of the content is for herbal remedies and vitamins.

[LeoPa in reply to AussieNeil]

Herbal remedies are going like hotcakes. Whenever I go to the pharmacy people are buying them like they cost next to nothing. But they are quite expensive. The country's largest chain of drug stores makes massive amounts of money on these.These buyers are the same people who then take loads of drugs prescribed by their doctors in order to treat their failing health which is failing on account of their lifestyle choices. Which they are unwilling to change. Sad state of affairs.

[Edalv in reply to AussieNeil]

I agree, the supplements industry is growing at a very accelerated pace and mostly unregulated. I wish organizations such as the FDA in the USA had a branch or arm testing some of the products and making more implicit recommendations. Also, let clarify what I mean by TCM, these are practitioners that have attended Oriental medicine school training at a certified school or university. For example the TCM practitioner I consulted also had an MD degree and worked at a major medical center before. He was also a 5 generation herbalist. TCM can be intimidating for a westerner, it was for me at the beginning, but it help me resolve some chronic sleep and digestive issues I had in the past. It didn’t help with my gout problem, so I decided to start a regimen of Allopurinol. Obviously, it’s not well suited for every health issues, specially acute health problems.

[MB60 in reply to flipperj]

I think your thoughts may be a bit dated, today our care is more influenced by insurance than pharma (at least in the US).

[AussieNeil Partner Administrator in reply to 2016Longevity]

FlipperJ may be referring to advertisements to the general public, which of note thankfully are only legally permitted in two countries, the USA and New Zealand.

[flipperj in reply to AussieNeil]

Yes. It's unrelenting in the US. Heck, I have actually been a part of it in the past in the creation of advertising which is displayed on the monitors in the Dr. waiting rooms. Classes I attended in university took place on the grounds of a major pharma company.

[2016Longevity in reply to AussieNeil]

the small prints are pronounced as well in the ads …

[flipperj in reply to 2016Longevity]

Ironically, the small print insert with my Venetoclax opened from a 2" cube to a 4' x 4' sheet but remained indecipherable without a magnifying glass. A fantastic drug BTW and my apologies for drifting off topic.

[Edalv]

Tradicional Chinese Medicine , TCM, has been around for 3,000 years It is usually effective for certain chronic condition. It is important to consult an experienced practitioner before going the self meditation route. In my humble opinion, there room to both, TCM an allopathy, depending on the situation. I would not dispose of 3,000 years of practical experience… but I would consult an experienced TCM practitioner before embarking on self meditation… 🙏

[AussieNeil Partner Administrator in reply to Edalv]

Interestingly, Professor Ezard Erntz has this to say about TCM in this paper Fallacies of esoteric medicine (EM) ncbi.nlm.nih.gov/pmc/articl...

Appeal to tradition

Many forms of EM have a long history, and proponents use this fact to convince the public of its value. Any treatment that has passed “the test of time”, they argue, must be effective and safe. After all, people are not stupid; why would they persist in using such treatments if they did not work or if it caused harm? Some enthusiasts even view the “test of time” as significantly more relevant than any objective evaluation of therapeutic effectiveness. Clinical trials, they insist, are of necessity artificial and relatively small-scale, while tradition is real and large-scale; EM has been field-tested on millions for millennia, they believe. A long history of use is therefore a more conclusive test than science can ever provide.

An established tradition can, of course, be a valuable indicator suggesting that a given treatment might be safe and effective. This might constitute a relevant stimulus for further research, but it never can provide solid proof. Furthermore, a long history might also just indicate that the origins of the therapy in question reach back to the days when the basic medical sciences such as anatomy, biochemistry and physiology were in their infancy; in this case, it would merely disclose not a strength but a significant weakness in its foundations.

Blood Letting was also a commonly accepted treatment for about 3,000 years, yet it was arguably the cause of death for the death of the first US president, George Washington. While it still has a few valid uses today, we no longer use it as a regular treatment for the wide range of conditions for which it was previously applied.

With CLL, we do rely on blood letting for diagnostic testing and some of us need it to treat Hemochromatosis. From healthline.com/health/blood...

Takeaway

While bloodletting may sound like an ancient clinical treatment, the principle behind it is still used in some — albeit rare and more medically sound — circumstances today.

Historic bloodletting was based on a limited view of disease processes. Today, blood removal is usually done for diagnostic purposes or as an evidence-based method to remove specific amounts of blood to achieve very particular results.

With respect to Hemochromatosis

Hemochromatosis is a genetic disorder that affects how the body processes iron. It can lead to an overaccumulation of iron throughout the body. Today, this condition is treated with periodic blood draws to keep ferritin — the protein that stores iron — at a healthy level.

With CLL, if we have the genetic predisposition for hemochromatosis, we are at more risk of needing treatment for it if we take an iron supplement to try and treat our anaemia when it's bone marrow infiltration from our CLL causing it, or if we need frequent blood transfusions to treat CLL related anaemia, such as from bleeds due to low platelets or bone marrow suppression caused by treatment drugs.

Neil

[Edalv]

I wouldn’t call TCM, a 3,000 year old practice an esoteric treatment, but the professor has the right to his opinion… 🙏

[AussieNeil Partner Administrator in reply to Edalv]

Professor Ernst does define esoteric medicine (EM) in his introduction, where he states, "The following terms are currently used frequently and almost interchangeably:

alternative medicine,

complementary medicine,

holistic medicine,

integrative medicine,

natural medicine."

He uses EM as "an umbrella term for a vast array of treatments (and diagnostic techniques), which have little in common other than being not regularly employed in conventional healthcare."

[LeoPa in reply to AussieNeil]

Which means that the professor is heavily biased. He should better explain why everybody is so sick if people like him involved in the conventional health care industry are so smart and all knowing that they feel like they can disregard the knowledge and opinion of all those other practitioners which do not fall in the conventional health care category. Why don't they just cure everyone and be done with it. You mentioned bloodletting as a practice that was employed once upon a time. I'm pretty sure that a lot of things which are being performed today by the conventional health care practitioners will be looked upon as a kind of a bloodletting in a few decades or hundred years. By now it is probably very apparent that I have a huge dose of skepticism towards anyone with a title claiming to be the smartest one in the room because his diploma says so 🤣.

[LeoPa in reply to Edalv]

If it can't hurt it's worth a try I think. Especially if the condition is not life-threatening and the patient is seeking relief trying to avoid loading up on drugs unnecessarily.

[MyCLLJourney in reply to LeoPa]

Exactly! I had meningo-encephalitis 2 years ago. 9 months ago, I was looking for ways to treat my constant nausea and getting sick. One month, I got sick 22 times! I went to a natural foods store looking for ginger chews, preferably without much sugar but they didn't have anything I wanted to try. The cashier showed me a homeopathic med that was supposed to help, so I said sure, I'll give it a try. What a miracle! I went more than a month without getting sick. Since then, I've only thrown up once in over 9 months! I dont even take the med any more.

I do take supplements, but you do have to make sure you have a good quality brand. You also have to watch closely to make sure it is providing a benefit for why you are taking it. While I agree there are many supplements out there without any qualities at all, it just means you need to do your homework! I got real lucky trying the homeopathic med and I'm so glad I did!

[LeoPa in reply to MyCLLJourney]

Though I am a big homeopathy skeptic if it works it works, and I'm glad that you found something that works for you!

[AussieNeil Partner Administrator]

I would say that esoteric as in "designed for or understood by the specially initiated alone" (Merriam Webster) - the special knowledge you mentioned, is a fairly good definition for the modalities Professor Erntz lists;

Some of the best-known modalities in German-speaking countries include the following:

acupuncture,

anthroposophical medicine,

applied kinesiology,

aromatherapy,

autologous blood therapy,

Ayurvedic medicine,

Bach flower remedies,

bioresonance,

chelation therapy,

chiropractic,

colonic irrigation,

detox therapies,

dietary supplements,

energy healing,

herbal medicine,

homeopathy,

iridology,

Kampo medicine,

macrobiotic,

magnet therapy,

mind-body therapies,

music therapy,

neural therapy,

ozone therapy,

Pilates,

reflexology,

Reiki,

shiatsu,

tai chi,

Traditional Chinese Medicine,

qigong,

yoga.

Professor Erntz is a strong supporter of evidence based medicine - the demonstrable modes you asked practitioners of TCM to provide.

Neil