Integrative Pediatric and Adolescent Health: Educational Web Column
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September 2008:
Herbs and Supplements
Part II:
From the personal to the professional
by David Becker, MD, MPH
In last month’s column I used a personal story to start a discussion about how to consider using herbs or supplements for specific medical purposes. This month’s column provides more background on the use of herbs and supplements, and some resources you may find helpful.
Regulation and Oversight
It is very difficult to know exactly what you’re buying when you browse the health product aisles. The Federal Drug Administration is responsible for regulatory oversight of the herb and supplement industry. But, the Dietary Supplement Health and Education Act of 1994 classified herbs and supplements as natural health products. This means that as long as no claims to diagnose, treat, or prevent disease are made in labeling, such products can avoid the stringent oversight that the FDA reserves for drugs. This means that the FDA does not test these products for proof of efficacy, safety, or that they contain what they say they do. Which makes it hard to know what’s in the bottle.
Thankfully, there are a few resources to turn to for help. The FDA set a standard of “Good Manufacturing Practices” in 2003 to help ensure the quality of production of natural supplements. Testing, however, is not mandatory. The US Pharmacopoeia has a voluntary program for companies that assesses for compliance with GMP. You can go to their web page and read more about what USP verification means and which companies have participated in their volunteer program:
Also, the private company, ConsumerLab, tests products for their contents and often for contaminants. Testing for contaminants is very important because several studies have shown that some herbal products (particularly from China or India) may contain toxic heavy metals and/or pharmaceuticals. Recently, though, some Ayurvedic herbs produced in the U.S. were also found to be contaminated with heavy metals and pharmaceuticals (abstract from the Journal of the American Medical Association). There is an annual subscription fee for access to ConsumerLab, but it is relatively inexpensive; and they have tested numerous products. If you are a frequent user of natural health products, you may find this a helpful resource. See below for a listing of additional resources.
It’s not always simple
Herbal preparations can be as simple as a hot infusion (i.e., a chamomile tea), or as complex as a dozen or more ingredients from a wide variety of sources (some Traditional Chinese Medicine remedies, for example). While our modern understanding of the components of herbal remedies is advancing, the complexity of the interaction of these substances with the body, with other herbs and supplements, and with pharmaceuticals limits, for many physicians, our comfort in their regular use. But, as I mentioned in my first column, if you don’t ask your physician for help, we’ll have less incentive to learn how best to help you. And if we don’t know what you’re taking (herbs, supplements, extra vitamins), we won’t know to be cautious about some of the medications we may prescribe for you.
Common herbs for pediatric and adolescent care
With that in mind, there are several herbal preparations that I use commonly with my patients. The information below is not intended as prescriptive instructions for the use of any of these substances. I specifically do not recommend the use of any of them without consulting your health care provider.
Calendula for infant rashes. Many over-the-counter products now contain calendula. It is safe and soothing for common irritant rashes.
Probiotics for multiple uses: constipation in infants on formula; the prevention of eczema and possibly asthma; the treatment of mild gastroenteritis; treatment or prevention of the diarrhea some children get when taking antibiotics.
Chamomile for colicky symptoms in some infants; mild abdominal pains; or as a relaxing tea. What’s important here is that in order to get the medicinal effect of the chamomile as a tea, you should use 3-5 tea bags and steep for 8-10 minutes. For children over a year of age, honey helps with any bitterness of a stronger tea.
Essential oils of eucalyptus or peppermint (menthol) for colds and congestion. As a salve on the chest to help with congestion; or as a steam inhalation for the same symptoms. These oils should NOT be applied around the nose or on the face.
Omega-3 Fatty Acids have diminished markedly as a natural component of our diet due to changes in the foods we eat. Taking a daily supplement in the form of fish oils or flax seed oil and other plant sources may have wide-ranging positive health effects.
There are many other examples of herbs, supplements, and specific vitamins that may be helpful in specific circumstances.
Neither the UCSF Osher Center nor Dr. Becker are advocating for the use of any specific products or brands. Dr. Becker has no financial ties with any pharmaceutical or natural health product company.
Resources:
ConsumerLab. This is a commercial web site that runs independent quality analyses on a wide range of herbs and supplements. They also have fairly good background information on products and what they may be used for. It is a subscription site, but low cost at only $25 a year. I use this site regularly as it provides one the best sources of information on the true content of herbal products (since there is very limited regulation of these products), as well as testing for contaminants.
National Center for Complementary and Alternative Medicine. This National Institutes of Health Center has a wealth of basic background information on herbs and supplements.
Natural Standard. A collaboration of a large group of researchers and clinicians from a broad range of academic backgrounds. This group reviews systematically the data on a large compendium of herbs and supplements. The resource is available primarily through university libraries, but downloads for your computer or hand-held device are available for an annual fee. I like their reviews and rely on them for a generally conservative but thorough approach.
Natural Medicines Database. This is another commercial site that offers detailed and helpful information about a large number of herbs and supplements. It is available at an annual subscription rate of about $49/year. One of the features I like is a listing of potential drug-herb interactions.
CAM on PubMed
A database on the Web developed jointly by NCCAM and the National Library of Medicine, offers citations to articles in scientifically based, peer- reviewed journals on complementary and alternative medicine.
The Cochrane Library
The Cochrane Library is a collection of science-based reviews from the Cochrane Collaboration, an international nonprofit organization that seeks to provide “up-to-date, accurate information about the effects of health care.” You can view the abstracts for free on their webpage
Clinical Trial Database
The Clinical Trial Database is the website of all dietary supplement clinical trials being conducted by the US government.
Health Canada
The Canadian government regulates natural health products in Canada licensing products with proof of safety and efficacy. The site has helpful monographs.
Longwood Herbal Task Force
Peer-reviewed monographs, clinician summaries, and patient information. Not a comprehensive site, but free and has excellent reviews and resources regarding the material is does cover.
About the Column
This column presents an integrative medicine view on a range of topics relevant to children, teens and early adolescents including: nutrition, herbs & supplements, mind-body and self-regulation skills, and general health and wellness.
If you’re new to the concept of integrative medicine, take a few minutes to browse the UCSF Osher Center web site, particularly the page what is integrative medicine?
Broadly speaking, integrative medicine is practicing good medicine. It is an approach to a child’s health that:
- places illness in the context of the child, rather than the child in the context of illness;
- takes into account family and environmental factors;
- neither rejects conventional medicine nor accepts complementary or alternative medicine (CAM) uncritically.
Integrative pediatric consultations are available at the Osher Center with Kevin Barrows, MD, Rick McKinney, MD, and Priscilla Abercrombie, RN, NP, PhD, AHN-BC. To make an appointment, please call the main clinic line at 415.353.7720.
David Becker, MD, MPH is an Assistant Clinical Professor in the Department of Pediatrics at the University of California, San Francisco, and Affiliate Faculty at the Osher Center for Integrative Medicine at UCSF. He is starting the Pediatric Integrative Pain Clinic in July 2008. This is a referral-based service for children and adolescents with chronic pain. For questions about referrals, please contact the main Mt. Zion Pediatric number: 415.885.7478.
In addition, we offer two healthy parenting stress reduction classes: Mind in Labor and Mindfulness-Based Childbirth and Parenting.
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