Natural does not equal safe: "You should remove that wort" edition

A study this month ($) in Pharmacoepidemiology and Drug Safety (just rolls off the tongue doesn't it?), looked at poison control data during 2001 for two herbal supplements: St. John's wort and Echinacea.

There were 356 contacts for SJW and 406 contacts for Echinacea. That's not what interests me; we know the compounds are bioactive and have toxicities associated with their use (See here for the adverse effects seen from these contacts). SJW is even implicated in suicidal and aggressive thoughts (Nanayakkara et al. 2004. Ned Tijdschr Geneeskd. 149; 1347-1349) and interferes with many prescription drugs, many times limiting the amount of active drug that your body is exposed to. What interests me here is that the percentage of young people experiencing adverse effects was lower than the adults (For Echinacea: 3.4 vs 28.9%; For SJW 14.4 vs 46.4%). Possibilities: 1) Since children's exposures were largely accidental, they took very little compared to the intentional adult exposure. 2) Children who ingest any supplement are more likely to be reported whether they have symptoms or not while adults are more likely to reported only if they take too much or experience adverse effects. 3) Children are less sensitive to Echinacea and SJW (not likely base on current evidence).

It would be useful to run this down to get some firm numbers on adverse reactions of children to herbal supplements (especially those which contain a lot of caffeine like guarana). The poison control center data is well known to underestimate exposure and toxicity due to severe underreporting (even for poisonings leading to death). Additionally, only contacts which Echinacea and SJW were the only associated products were included to keep the analysis clean. The bigger point, however, is that poison control centers get contacts every year (by the numbers, at least a couple a week) about harmful effects of children or adults taking Echinacea or SJW.

So, I know it's legal and natural* but it's not safe; that goes double if you've got kids in the house. Oh, and shouldn't GNC et al. put their snake oil into child safe bottles? Not that they really care about anyone's health anyway, but it's nice to dream.

*I don't consider it natural as it's extracted and processed. It's like saying digoxin is natural becuase of foxglove; or gasoline because of crude oil.

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Sure "natual" products are bad, but they're not half has bad as "oranic" products. I speak from experience.

Waaaaait for it...

Welcome to ScienceBlogs. I'm delighted to see a fellow toxicologist.

Cheeto

Natural is not necessarily safe. Hemlock can be organic and natural but it will not improve your day. Neither will poison oak, castor bean, delphinium, foxglove and a host of other natural plants.

CheetoToxicologist,
You wrote 'cheeto' and 'toxicology' in the same post. I love it.

Thanks, I'm delighted to have other toxicologists read it.

My usual response to the "But it's all natural" crowd:

So's rattlesnake venom!

Gah! Fine, no one caught on to my initial comment... AngryToxicologist, look at how you spelled "natural" in the title of this post and then read my first comment.

I noticed you mispelled 'oranic' but I let it go. It's a good thing I didn't, the irony would have killed you. ;) Thanks for keeping my spelling on at least a 4th grade level.

It was all intentional! iiinteeeentionaaaal!!

Hey. Crude oil is natural. Comes from the Earth, too.
Gaia's milk, baby.

Both matthew and llewelly,
That was my point (matthew, it would be ironic because you're misspelling was intentional) (llewelly, I was saying crude oil is natural, gasoline is not).

Am I speaking Greek? Maybe it's the friday caffeine and I'm not thinking straight. I think I give up.

You know what's all natural?

Poop.

Most of us don't take any prescription drugs, so we will stick to natural and organic stuff, and stay healthy, thank you.

The data that says herbs are harmful and "interfere with many prescription drugs" are obviously from studies paid for by the pharmaceutical industry, that want people to stay hooked on prescription drugs.

356 contacts is not a whole lot is it, honestly (How many people are suffering from so-called side-effects from prescription drugs? "Side-effects"?) And from that you conclude that "it's not safe"?

It always amazes me that natural products are pooh-poohed but we can take toxic drugs, which kill many thousands every year and that is ok. Check the hospital stats for the people who are admitted from reactions to drug. With any product, natural or prescribed, it would behoove one to do their homework for any possible side effects. There is a site, drug digest, which shows interaction with drugs and with herbal products. All in all, I have found that natural products are much safer to take. However, one needs to be educated in taking these.

Nice post!

I would like to see the herbal market thrive, but not at the expense of safety, as you say. It's a shame more money doesn't get spent on safety trials.

Another aspect that concerns me is filler content. I see a lot of glycerin in oil-based supplements, and I wonder if that glycerin is coming from China.

Also, great idea about child-safety caps!

Bix

All in all, I have found that natural products are much safer to take.

Not really... if you take into account the results of the condition/disease in question that isn't being helped by said natural product.

I'm certain that coffee enemas have milder and fewer side effects than chemotherapy, but death by cancer is a bitch of a side effect.

I would like to see the herbal market thrive, but not at the expense of safety, as you say. It's a shame more money doesn't get spent on safety trials.

Another aspect that concerns me is filler content. I see a lot of glycerin in oil-based supplements, and I wonder if that glycerin is coming from China.

Also, great idea about child-safety caps!