Apr 11 2019

Herbals Potentially Unsafe in Pregnancy

I know this blog is a metaphorical finger in the dike of a massive corporate advertising and misinformation campaign, but I need to say it as often as possible that herbal products are drugs. They are consumed or applied for the pharmacological effects of the chemicals they contain. But they are advertised as “natural” which is somehow magically supposed to alter that reality.

Many people, I suppose, don’t contemplate the fact that arsenic, hemlock, curare, strychnine, and countless other chemicals are all natural powerful poisons. The natural world is full of toxins, poisons, and powerful drugs. To a first approximation the natural world is trying to kill you. I would not, for example, recommend eating any part of a plant you cannot identify. Those are not dice you want to throw.

Literally centuries of snake oil marketing, however, has created a health halo around the vague concept of something being “natural”. The herbal supplement industry makes billions off this misconception, and of course does everything it can to promote it. Even the term “herbal supplement” is a misnomer – the result of the industry lobbying the government to treat these unpurified dirty drugs as if they were food.

As a result we have a drug industry that is largely unregulated and sells their products directly to the consumer, without prescription or any medical oversight, and are allowed to make or imply all sorts of health claims. Their products are rife with contamination, substitution, mislabeling, and adulteration. Even when the label is accurate, we often don’t know what the active ingredients are, their doses, or their interactions.

Further, when studied carefully these products usually do not work for their marketed indications. Echinacea does not reduce cold symptoms. Gingko biloba does not help memory or prevent dementia. Black cohosh does not work for hot flashes.

Also, because herbals are drugs, they have potential drug-drug interactions. This means they can adversely affect important prescription medications.

Taken together, all this means that the net health effect of the herbal drug industry is probably not good. Americans are spending billions of dollars to worsen their health, not help it. A newly published review supports that conclusion. This study is a review of studies looking at potential side effects of taking herbal product during pregnancy. They found:

A total of 47 herbal medicinal products and 1,067,071 women were included in this review. Use of almond oil was associated with preterm birth (odds ratio 2.09, 95% CI 1.07–4.08), oral raspberry leaf was associated with cesarean delivery (adjusted odds ratio [AOR] 3.47, 95% CI 1.45–8.28); heavy licorice use was associated with early preterm birth by 3.07-fold (95% CI 1.17–8.05). African herbal medicine mwanaphepo was associated with maternal morbidity (AOR 1.28; 95% CI 1.09–1.50), and neonatal death or morbidity. Fourteen studies reported absence of adverse events. Four studies reported herb–drug interactions, but none studied adverse events arising from them.

Those are serious side effects – including preterm birth, increased risk of C-section, and even death. This is also just the tip of the iceberg, because herbal products are largely not studied. Companies don’t have to study them, to provide any evidence of even basic safety, before putting them on the market. Herbs that have been around for a while are designated as GRAS – generally regarded as safe. This means – no testing required.

At this point you might be thinking, but if there are independent studies showing risk, why can’t the FDA recall those products? That is because of the regulations passed in 1994, which makes it very difficult for the FDA to take action. The burden of proof is on them to demonstrate that harm is actually happening, something which they are rarely able to do. The FDA mostly contents itself with writing strongly worded letters, most of which are ignored. Even when their finger wagging is effective, it’s a game of whack-a-mole. Another company (or just the same company by a different name or outlet) will just crop up and start selling the same snake oil.

The result is that the entire herbal product industry is a giant scam. That doesn’t mean there are no herbs with useful chemical ingredients. Sure there are. They have mostly already been identified and purified, and there is ongoing research into potentially new useful substances. But marketing unpurified, unstudied herbs with a mix of many chemicals, many unknown, with highly variable doses and bioavailability, drug-drug interactions, and potential toxicities is reckless, to say the least. And further to allow this snake-oil industry to largely regulate itself, with a weakened FDA that doesn’t have the teeth to punish wrongdoers, is nothing short of malfeasance.

We don’t have to guess what the result of this lack of regulation is. We now know it – products that are frequently contaminated with potential toxins, with ingredient substitution, with illegal adulteration with actual regulated drugs, and with variable dosing. We also now know that most of these products do not work as advertised, and are not even safe. And yet we allow the industry to lull the public into a false sense of security (because it’s all natural) to the point that pregnant women feel comfortable taking these dirty drugs.

These are all undeniable facts, and yet when you point out these facts, with proper citations, you are almost guaranteed to be accused of being a “pharma shill.” That is how strong the propaganda and marketing is. Never mind that many herbal products are sold by large pharmaceutical companies, because – why not? They are an unregulated cash cow. Supplement manufacturers have themselves become big pharmaceutical companies. So the false charge of being a pharma shill doesn’t even make sense.

The “shills” are the ones spreading pro-herbal-snake oil propaganda. Just think about it – the industry that is lobbying the government to be unregulated, and selling bogus and largely untested products with false claims and a slick narrative is the supplement industry. Yet they have convinced many people that their critics are the ones who are corrupt. It is a great example of gaslighting – creating a distorted view of reality by systematically misinforming and pushing a false narrative.

But for those who are interested – the evidence is all there (what we have so far). This study adds one more piece. Don’t take herbal drugs while pregnant under the false assumption they are safe.

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