How Effective are Herbal Remedies?

Updated 1/1/2019

Walk into your local pharmacy. You’ll see more space devoted to herbal remedies and supplements than actual medicine.

But wait, “actual” medicine? What do you mean? I can already hear some thinking “but herbal remedies are just as good as the junk Big Pharma is pushing, right? I can cure myself using what nature provides!”

This article will consider the medical efficacy of some of the more popular herbal remedies: echinacea, ginkgo, st johns wort, black cohash, saw palmetto, glucosamine and chondroitin as well as the supplement industry as a whole. Hopefully after reading this, you’ll have a good understanding of how effective herbal remedies are.

Herbal remedies cannot be completely dismissed out of hand. Similar to how antibiotics are derived from fungus and bacteria, many medicines were originally derived from herbs. Looking back in history, we see numerous cases where an herbal remedy was studied and the active ingredients were isolated. Willow bark extract is refined to make aspirin. Cinchona bark extract was refined to create quinine, an anti-malarial drug. This means that there is no blanket statement to be made on the efficacy of herbs. Each herb must be reviewed on its own merits with some being worthy of consideration. However, studies are extremely expensive and most plants will not have a proven efficacy. One study cited in this article cost 12 million dollars. That’s a lot of money to lay on the line just to prove if a particular flower actually does anything. Herbal companies do not have to prove medical efficacy so they avoid all of the expensive clinical steps in order to push a product out the door.

Natural products vary greatly in the amount of active ingredients that they contain. They vary from year to year and batch to batch. Consider it in the same way as vintages of wines having markedly different qualities. Soil content, humidity, pest/herbicides, location, and many other factors play into what a given plant goes through from season to season.

Since herbal supplement manufacturers are not held to the same standards as manufacturers producing medicine, you do not know what you will be getting from each given bottle and from each given manufacturer. Rather than 75mg of acetylsalicylic acid being in every tablet in every bottle, you get some amount of crushed flower that may or may not contain the amount of the same active ingredients as the next bottle in the row. You may not even be getting any active ingredient at all. In a related case, the Infectious Diseases Society of America study showed that probiotic supplements, cousin to the herbal supplement industry, sometimes contain inactivated ingredients. Rather than a live organism, a dead organism was sold. If a similarly unregulated industry predicated on the (completely unproven) idea that ingesting live bacteria in pill form will improve your health, what do you think that the unregulated herbal supplement industry is doing?

Speaking of lack of regulation…

Works best when it is still in your garden
Works best when it is still in your garden

Since there is no standardization process, there is often contamination present. Many studies have found contamination ranging from belladonna, staph, salmonella, aflatoxins, pesticides, insecticides, fumigation byproducts, and toxic metals such as arsenic and cadmium. Surprisingly, actual medicine has been found in herbal supplements. Some herbal supplement manufacturers will include actual painkillers in their supplement pill to give actual relief. Just remember: there is no required quality assurance check for herbal medications since they are not governed by the FDA. There is no requirement for safety or proven efficacy. That’s why there’s the disclaimer on the bottle that says that this product has not been evaluated by the FDA to treat or prevent any type of disease or injury.

Now that we’ve discussed the industry, let’s look at some case studies. First up is a previously discussed herb called echinacea.

Echinacea is used in almost all combination herbal remedies. Almost all modern studies have shown it to have absolutely no medical efficacy. A recent study used alfalfa as a placebo against preparations of echinacea. Surprisingly (not really), echinacea was shown to have no difference in symptom reduction compared to the placebo. Unsurprisingly, the naturopaths disagreed. Naturopaths complained that the preparation was not prepared correctly. This is the often cited reason that other similar sham-medical treatments failed. Some go so far as to say that you have to wear a certain type of leather glove. Some talk about phases of the moon. Regardless, it’s all bunk. My favorite reason given by naturopaths that echinacea was shown to have no benefit over placebo was that the placebo was actually a useful treatment too. The irony of that statement was likely lost on the naturopath that said it. Regardless, the study was repeated with the complaints addressed. There was even use of direct application of illnesses via mist-spray to ensure that the test group was actually infected. The results were the exact same.

The running theme here is that rather than isolating the useful chemicals from the herb, studying impact on animals, then synthesizing a concentrated dose for use in clinical studies, herbal remedies are generally just a mashup of flowers to give a random dose of random chemicals with little in the way of research performed. After all, if it was proven to work, we’d just call it medicine.

Next up is everyone’s favorite: ginkgo. This little herb is often recommended for improving memory. I forgot how that’s supposed to work. Heh. Oh wait, the supposed mechanism for action is by increasing blood flow to the brain.

This concept first came about in the 1960s. Certain studies have shown statistically significant results from animal studies. However, use in humans has yet to demonstrate any results. A study published in JAMA showed that over a six week period, gingko was no better than placebo in improving the memory of elderly patients. Another study in Alzheimer’s patients demonstrated enough of a difference from the test group and the placebo group that there may be some improvement. However, the results were ultimately inconclusive.

Some would say that since gingko has been used in traditional Chinese medicine for thousands of years, that there must be some validity to the idea that it is useful. That’s what we like to call an “Appeal to the Ancients” fallacy. The ancients had little in the way of virology, immunology, physiology, and only a basic idea of anatomy. There was little idea for how diseases worked beyond the most recent few hundred years. The ancients had nothing that could be called knowledge of epidemiology. There was also no true way to verify efficacy of anything used as medicine since up until around the 11th century, there was no scientific method. Up until that point, introspection and metaphysical debate were largely used in place of true science. Some could argue that Aristotle’s empricism formed a primitive scientific method; however, the lack of causal determination makes that argument largely invalid (and irrelevant to the main question of herbal remedies!).

Let’s look at another herb: St Johns Wort.
In case anyone was wondering, wort is the archaic term for “herb.” This plant is named for the red resin secreted by glands in the flower. What do the herbalists claim that it can do? We see this sometimes used as an antidepressant, as an anti-inflammatory agent, and sometimes as an antibiotic in ancient times. A large amount of studies on the topic focus on the antidepressant aspects claimed by herbalism practitioners. Some early small-scale studies have shown some minor benefit to those suffering mild depression. However, the same studies showed that it was inferior to placebo in treating to severe depression. One confounding factor is that mild depression is heavily reliant on self-reporting and, as such, suffers from having subjective results. Another confounding factor in studies is that different studies use different extracts so there is little way to determine that a particular active ingredient is actually performing a medically useful intervention. As a result, it is impossible to dismiss this herb out of hand. Some extracts may actually be useful when concentrated; however, it is required in concentrations not seen in typical herbal preparations. Another problem is that this herb is not without risks. Side effects and drug interactions can be severe in some patients.

On to the next herb!

Saw palmetto is an herb that is often recommended for treating what a doctor would call benign prostate hyperplasia. This is where the prostate gland becomes enlarged resulting in a decrease in urine flow. Saw palmetto is also adovcated by herbalist for treating the atrophy of testes, infertility, decrease in female lactation, as an appetite stimulant, as a toxin expectorant, and treating impotence and erectile disorder. After the 1960s, there also was a rise in the belief that it could improve general prostate function. The purported mechanism it does all these things by is through interfering with the synthesis of testosterone and/or by blocking testosterone receptors. There was a large study published in the New England Journal of Medicine that showed no biological changes shown when compared with a placebo. This study primarily looked at deterministic factors like urine flow rate, urine volume, and prostate size. There was no visible change between the test group and control group. However, there was a noted report that people felt they were improving despite all signs to the contrary. This is a good example of why subjective measurements should be taken with a grain (if not more) of salt.

Black cohosh is pretty... pretty ineffective.
Black cohosh is pretty… pretty ineffective.

Next!

Glucosamine and chondroitin were believed to improve joints and decrease osteoarthritis since they are present in joints. However, your body synthesizes the materials that it needs from primative precursors rather than isolating the materials directly from the things you eat. Just because you’re eating a source of chondroitin doesn’t mean that your body will recognize it and deliver it whole to your joints. Rather, your body will break it down and reassemble what it needs from what you’ve eaten. So far, studies of these two supplements have shown questionable (if no) benefit. These studies were sponsored by Big Supplement (the manufacturers) and even then the results still did not support the sponsor’s hopes. The New England Journal of Medicine study conducted showed that meta-analysis of these studies had “questions regarding the scientific qualities of the studies” which basically means that the study was bunk from the beginning. Overall, there have been shown to be no benefit in clinical studies. In fact, some studies have shown better response from placebo rather than the glucosamine/chondroitin preparation. However, in all fairness, other subgroups showed a greater response from the glucosamine/chondroitin preparation. If I was a better badger, I’d wager that this is just natural statistical variation. One could argue that more studies are needed but studies are pretty expensive.

Let’s talk about one more herb.

Black cohosh. There’s a belief that this treats kidney problems, rheumatism, backaches, malaise, menopause, hot flashes and probably a few other things. How does it work? Who knows! Some say that it interacts with opiate receptors to cause intervention but that hasn’t been proven yet. There was a clinical trial for menopause related complications conducted which compared black cohosh to a multi-botanical containing black cohosh and 9 other ingredients. There was also a placebo group and a group getting the medically accepted method of hormone treatment.  The only actual medical efficacy found was in, surprise surprise, the hormone treatment. Naturally, the naturopaths came out to cry foul because “the trials did not simulate the whole person approach” which means the clinicians did not supplement medicine with not-medicine.

Coming all the way back around to a conclusion…

I think that at this point, it’s safe to say that most herbal supplements you see in the drug store should be avoided. There’s no quality control to make sure that what you’re buying is what you’re getting. Even if you get what you think you’re getting, you’re probably not getting anything that will do anything. If that isn’t a good enough reason to steer clear, I don’t know what is.