October 2003

Label info varies for common herbal supplements

The Archives of Internal Medicine, a publication of the Journal of American Medical Association (JAMA).

According to the article, over the past ten years, the use of botanicals and dietary supplements (BDS) — including herbs, neutraceuticals, complementary or alternative medications, phytomedicines or phytopharmaceuticals — by the American public has increased by an estimated 380 percent, with sales of over $600 million in 1998 for herbal products alone.

Standards for ingredients and recommended daily doses of BDS have not been established by any regulatory arm of the U.S. federal government. Standardization of these products may be difficult because plant products are composed of a number of chemical components and each may have varying levels of biological activity. Additionally, components may differ depending on the part of the plant used (for example, root vs. leaves) growing and harvesting conditions and formulation (for example, capsule, extract or tea), so that even products using the same plant parts may not be identical.

Judith Garrard, PhD, of the University of Minnesota – Minneapolis, and colleagues examined product variability based on label information for the 10 herbs with the greatest sales in 1998: echinacea, St. John’s wort, Ginko biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian.

Products available to consumers for each of the ten herbs were collected from 20 retail stores (six grocery stores, three retail pharmacies, six discount stores and five health food stores) in a large metropolitan area in January 2000. The researchers did not analyze the actual ingredients in these products.

The researchers used information from a recent textbook on botanicals and dietary supplements written by clinical/academic pharmacists as a benchmark for ingredients and recommended doses for each herb.

The researchers compared products for each herb with the benchmark, evaluating ingredients and doses given on the product label against the doses and ingredients recommended by the benchmark. They also looked at the proportion of products for each herb that was consistent with the benchmark-recommended doses and ingredients; and looked for markers (such as brand, type of store, or price) for each herb that might be used to identify products that were consistent with the benchmark.

The researchers found that in their sample, consumers had a choice of 880 products marketed under 241 different brands for the 10 herbs. Among the 880 products, 43 percent were consistent with the benchmark in ingredients and recommended doses, 20 percent were consistent in ingredients only, and 37 percent were either not consistent, or label information was insufficient to make a comparison with the benchmark.

In four of the 10 herbs (echinacea, St. John’s wort, saw palmetto, and valerian), half or fewer of the products were consistent with benchmark ingredients. Among all 10 herbs, echinacea had the fewest number of products (30) consistent in ingredients, while ginseng had the most (113), write the authors.

The researchers also found that price per label-recommended dose was a significant predictor of consistency with the benchmark, but store type was not.

“Persons self-medicating with an herb may be ingesting ingredients substantially different from that recommended by a benchmark, both in quantity and content,” the researchers write. “Higher price per label recommended dose was the best predictor of consistency with a benchmark. This study demonstrates that health providers and consumers need to closely examine label ingredients of presumably the same or similar herbal products.”

Source: Journal of the American Medical Association, Archives of Internal Medicine, 2003: 163; 2290-2295.

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