This kind of conflicting information is dangerous when you consider two things: First, serious liver toxicity from herbal supplements appears to have dramatically increased over the past 10 years (almost 20 percent of the serious liver-toxic events from pills are from supplements now). Second, there is no guarantee or foolproof law or ruling in place that ensures that the herbal supplements you purchase contain exactly what's listed on the label—or that they are even clean.
What gets lost in this cacophony are 7 simple tips I use to ensure that what I think I'm buying is what I'm actually buying.
#1: Take a healthy dose of cynicism first. Imagine a world in which you are supposed to drive 55 mph max on the highway and the cops came out with a statement that there will be few to no patrol cars monitoring your speed; they will simply trust that you'll obey the law. Is that an effective way to protect drivers? Of course not! Because speeders know that they're probably not going to get a ticket, so it's all pedal to the metal.
This is exactly what's going on with herbal supplements. Companies claim to follow cGMP (certified good manufacturing practices), but we really don't know if their claims are true unless an outside party tests their products or they get caught for doing something wrong. The Food and Drug Administration (FDA) does not have the bandwidth to enforce this ruling on a large scale, so don't get overly excited if a supplement company claims it follows the FDA cGMP.
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#2: See if it's been independently tested for quality. Several indpendent third-party groups certify that products have been quality tested. NSF is, in my opinion, the best quality-control insurance that exists right now for herbal supplements and supplements overall. In fact, it is also the only quality-control group that actually does on-site auditing or checking of a facility every six months. Ideally, the herbal supplement you're considering has an NSF label on the bottle, which means that individual product was tested. The seal also means that the company tests for all sorts of bad things you don't want, such as herbicides, pesticides, and heavy metals. An NSF label on the brand's website is still great, but it only means the facility in which the supplement was produced follows the FDA rules on quality control.
Another very good independent quality-control group is USP (U.S. Pharmocopeia), and if the website or bottle label indicates this certiciation, then you can feel good that what's reported on the label is actually what's in the bottle. The on-site monitoring accomplished by this group appears to take place at intervals longer than every six months (on average, every few years), which is why I did not rank USP as number one. Nonetheless, the group does excellent testing.
Natural Products Association (NPA) is another good group that appears to audit every year or more. When a product carries the NPA label, it indicates the company is also following the FDA's quality-control rules.
So, you might ask, what is the catch, Dr. Moyad? Why doesn't everyone just sign up with one of these associations? Good question. And the answer is it costs money that many companies simply do not want to spend, and every six months, every year, or even every few years seems too daunting for many companies. Yet, in my opinion, the cost is minimal because the risks in terms of potential insurance costs and litigation are large.
#3: Check for a Consumerlabs.com listing. Consumerlabs.com requires a membership fee to access all its information, but for many folks it's worth it. This group tests all kinds of products for quality and reports the results of its findings. Once in a while the group is criticized because it doesn't have an on-site laboratory but commissions others to test products. Still, I think that any testing is a good thing, so the criticism does not have much merit. Regardless, you can periodically check the site to determine which supplements rank high or low in terms of quality-control testing. The list of herbals Consumerlabs has tested and reported on is not extensive, but it includes enough of them to make you feel better that a product has earned the certification when making your purchase.
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#4: Look at the Center for Science in the Public Interest (CSPI) reviews. CSPI is a reputable group that reports on the evidence and conducts periodic quality-control testing of supplements. Overall, I find that CSPI is objective, its findings are well researched, and the staff that reports on dietary supplements is excellent. Since CSPI follows quality control only intermittently, it's not the best place for all the quality information on a product, but the group does regularly produce evidence-based reviews of herbal products for medical conditions, so overall, it's a good source.
#5: Check Consumer Reports reports. The same independent and non-commercial group that tests everything from blood pressure monitors to cars and vacuum cleaners also regularly follows stories or issues to do with dietary supplements. Overall, its reporting is objective and interesting, and the group tends to require a certain level of evidence to endorse any product. There are times when I disagree with Consumer Reports' take on the clinical research, but when it comes to protecting the safety of the public, they are spot-on. The fee for the group's newsletter and more extensive website access is worth it.
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#6: Make sure it's the product the research supports. Look for the specific herbal product used in the clinical trial that showed it may have helped (or hurt) with your condition of interest. It should also have a good safety record and a standardized ingredient. This is especially useful if you can't find an herbal that is certified by NSF, USP, or NPA.
For example, butterbur extract for migraine prevention was given a "Level A" (one of the highest ratings, which means it's considered "effective") by a subcommittee of the American Academy of Neurology and the American Headache Society in 2012 in the medical journal Neurology. However, the study failed to emphasize that the specific product used is called Petadolex. Since that's what was tested, that's the product I would recommend.
In other words, I reward and trust the products that have gone through the most human research on efficacy and safety. So the next time you hear about a positive or negative herbal supplement study, just look at the medical paper online and check the materials and methods section to see exactly what commercial product was used.
#7: Don't do your research alone. Assemble a team that you can trust with you and your supplements. Doctors get criticized a lot for not knowing about supplements, but many of them know everything else about you, so it's critical that they know what supplements you are taking to get a complete picture of your health.
Another person to consider putting on your team is your pharmacist. Pharmacists know a lot about drug-herb interactions. Nutritionists know a lot about which foods might substitute for a pill. And the beat goes on and on.
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