Abstract

The growing popularity of botanical dietary supplements (BDS) has been accompanied by concerns regarding the quality of commercial products. Health care providers, in particular, have an interest in knowing about product quality, in view of the issues related to herb-drug interactions and potential side effects. This study assessed whether commercial formulations of saw palmetto, kava kava, echinacea, ginseng and St. John's wort had consistent labeling and whether quantities of marker compounds agreed with the amounts stated on the label. We purchased six bottles each of two lots of supplements from nine manufacturers and analyzed the contents using established commercial methodologies at an independent laboratory. Product labels were found to vary in the information provided, such as serving recommendations and information about the herb itself (species, part of the plant, marker compound, etc.) With regard to marker compound content, little variability was observed between different lots of the same brand, while the content did vary widely between brands (e.g. total phenolic compounds in Echinacea ranged from 3.9–15.3 mg per serving; total ginsenosides in ginseng ranged from 5.3–18.2 mg per serving). Further, the amounts recommended for daily use also differed between brands, increasing the potential range of a consumer's daily dose. Echinacea and ginseng were the most variable, while St. John's wort and saw palmetto were the least variable. This study highlights some of the key issues in the botanical supplement market, including the importance of standardized manufacturing practices and reliable labeling information. In addition, health care providers should keep themselves informed regarding product quality in order to be able to appropriately advise patients utilizing both conventional and herbal medicines.

Highlights

  • Over the last 10 years, complementary and alternative (CAM) therapies have grown into a multibillion dollar industry in the United States [1,2,3,4]

  • Health care providers who are currently hesitant to recommend or discuss botanical dietary supplements (BDS) use with their patients [9,10,11,12] would likely be less reticent if they were confident about the product quality

  • Consistent with previous studies [6], the current study found that product labels of BDS vary in the information provided

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Summary

Introduction

Over the last 10 years, complementary and alternative (CAM) therapies have grown into a multibillion dollar industry in the United States [1,2,3,4]. The use of botanical dietary supplements (BDS) has surged, with more than 60 million Americans using herbal or other supplements, and spending over $600 million annually on botanical products alone [5] This new era of popularity with BDS in the United States is accompanied by questions regarding the quality, consistency and safety of commercially available herbal products. With the rise in the simultaneous use of both herbal and conventional modalities [8], health care providers, in particular, have a vital stake in knowing what their clients are consuming and in assessing the quality of these products. Health care providers who are currently hesitant to recommend or discuss BDS use with their patients [9,10,11,12] would likely be less reticent if they were confident about the product quality

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