What you need to know about herbal treatments

1. Lack of regulation - Herbs are considered food supplements and, as such, are not regulated by the Food and Drug Administration (FDA) in the same way medications are. That means whatever is put into a bottle, is not overseen by any externally mandated standards. It only has to follow the standards of the company that manufactures it. Risks include the possibility of contaminants, inadequate amounts of herb, the wrong herb and unwanted additives. If you try something, use only brands that you know are from large, reputable companies that would have a lot to lose if they provide an unsafe product.
2. Lack of evidence - Food supplement manufacturers do not have to provide any evidence for their "claims". They have to be careful about how they word things - but they can use wording to make you believe they actually have evidence that a certain supplement can make your sex drive better or whatever the symptom may be. A good resource for herbs is the natural medicine comprehensive data base. It costs money to subscribe to this, but it is an excellent resource listing all of the research that has or has not been done on a particular herb. It also lists things to watch out for if using a specific product. The website is listed in the web resource section.
3. No guarantee of safety - Remember that because food supplements are not regulated and don't have to provide evidence for any claims, they have likely not been researched. For many herbal and food supplements, there is no information that provides insight into what dose is needed, what the active parts of the herb are, whether manufacturing destroys whatever value the active herb has in the wild, what medicines might negatively interact with the herb and what side effects can be seen with the herb. Therefore, anyone taking such a product is really gambling with all of those unknowns. Many of the medications we use today which are quite toxic, such as digoxin for heart conditions and some chemotherapy drugs for cancer have come from plant sources. That is what herbs are - plants. Just because a plant grows in the wild, doesn't mean it isn't a toxic substance with possible side effects.
4. Popular treatments - myths and facts
1. St. John's Wort - This herb has been very popular as a "mild" antidepressant. Women that feel like their mood changes a lot may want to try this herb. Beware: Research has recently revealed that this herb interferes very strongly with the cytochrome P450 system in your body. This system is the way our body processes, detoxifies and eliminates medications and other substances from our body. Research has shown that people who take St. John's Wort with a medication used for colon cancer (irinotecan) have less colon cancer medication in their system⁴³ than they are supposed to. In essence, they are getting too low a dose of the cancer fighting medicine. There may be other medicines that are affected by St. John's Wort because of these P450 pathways. Therefore, it is not recommended that St. John's Wort be used with other medicine.
   
   Black cohosh - There has been a lot of controversy over black cohosh and whether it is effective for hot flashes and also whether it is safe for women with a history of breast cancer to take. There is research from Europe, Germany in particular, that says black cohosh helps menopause symptoms. A small study done in the US looked very promising as well.⁵¹ However since then, there have been two large, randomized, placebo controlled trials which is the strongest type of study (meaning that the results of such a study are thought to be very reliable). Both of them showed that black cohosh did not decrease hot flashes and was not better than a placebo.^{33 50}
   
   Black cohosh does not appear to be a strong remedy for hot flashes based on limited research in the US. There are other concerns about the safety of black cohosh. One of the concerns is does it help breast cancer grow? The second is does it harm the liver?
   
   Several studies have looked at whether black cohosh may make breast cancer cells grow. Most of this research done in the lab shows that black cohosh does not act like estrogen does with respect to breast cells.^{39 44} However, the safety of the long term use of black cohosh in women with regard to breast cancer has not been studied well enough for a conclusive answer.
   
   With respect to liver toxicity, there are a handful of case reports stating that people taking black cohosh had developed liver problems, with one person having irreversible liver damage. Many of the people in the case reports were on other herbs and the doses of all of the herbs were not provided. Therefore, it is very sketchy information. There have been numerous studies with black cohosh, none uncovering liver issues. However, this is another issue that has not been well studied.



2. Soy - Soy is a popular product taken for hot flashes. Multiple studies have looked at various soy products for hot flashes and only 2 had positive results. Of these two positive studies, the results are not clearly positive. Participants had fewer hot flashes on soy at one time period but not others. Therefore, many health care professionals familiar with the published literature feel the overall consensus is that soy does not reduce hot flashes.



3. Chasteberry, Red Clover, Hops, dong quai and licorice - It is likely that you will see any or all of these herbs in preparations for menopause symptoms. The reasoning is that all of these herbs have estrogenic activity and would, therefore, be presumed to be effective for hot flashes and other estrogen deficient symptoms. A very well done study looked at the estrogen binding of these herbs and found that chasteberry, red clover, and hops had very strong estrogen receptor binding capabilities.⁴⁴ Dong quai and licorice were weaker but active and they did promote cell growth. Therefore, if estrogen is to be avoided, so should these herbal supplements.