Use of Herbs Among Adults Based on Evidence-Based Indications: Findings From the National Health Interview Survey

doi:10.4065/82.5.561

Mayo Clinic Proceedings

Volume 82, Issue 5, May 2007, Pages 561-566

https://doi.org/10.4065/82.5.561 Get rights and content

OBJECTIVE

To examine the extent to which US adults use herbs (herbal supplements) in accordance with evidence-based indications.

PARTICIPANTS AND METHODS

The Alternative Health supplement of the 2002 National Health Interview Survey (NHIS) is part of an annual, nationally representative survey of US adults. It contains data on adults' use of the 10 herbs most commonly taken to treat a specific health condition in the past year (January 1 to December 31, 2002). The Natural Standard database was used to formulate evidence-based standards for herb use. These standards were applied to the NHIS data to identify groups of people who used herbs appropriately and inappropriately, using a multivariable logistic regression model.

RESULTS

Of the 30,617 adults surveyed, 5787 (18.9%) consumed herbs in the past 12 months; of those, 3315 (57.3%) used herbs to treat a specific health condition. Among people who used only 1 herb (except echinacea and ginseng), approximately one third used it consonant with evidence-based indications. Women and people with a college education were more likely to use herbs (with the exception of echinacea) concordant with scientific evidence. Adults younger than 60 years and black adults were significantly less likely to use herbs (with the exception of echinacea) based on evidentiary referents than their counterparts. However, for echinacea users, no significant differences were detected.

CONCLUSION

Roughly two thirds of adults using commonly consumed herbs (except echinacea) did not do so in accordance with evidence-based indications. Health care professionals should take a proactive role, and public health policies should disseminate evidence-based information regarding consumption of herbal products.

Section snippets

PARTICIPANTS AND METHODS

This study is based on data from the Alternative Health/Complementary and Alternative Medicine supplement, the Sample Adult Core component, and the Family Core component of the 2002 NHIS.²⁰ The NHIS is an ongoing cross-sectional survey of a nationally representative sample of the civilian noninstitutionalized household population of the United States. Both basic health and demographic information are collected on all household members, generally on the basis of a face-to-face interview, but

RESULTS

Of 609 eligible study participants, 64.8% were women and the mean ± SD age of the population was 41.4±14 years (range, 18-85 years). Most of the eligible population (81.3%) was white (non-Hispanic white), with 8.1% being black, 7.9% Hispanic, and the remaining 2.7% of other ethnicity. Approximately one fourth (25.9%) of the eligible participants had an education level lower than or equal to a high school diploma, 59.1% had a post-high school or college equivalent education, and 15.0% had a

DISCUSSION

To our knowledge, this is the first large US population-based study of whether consumers use herbs in accordance with evidence-based indications. Although previous studies have explored the reasons why people take supplements, they did not generally evaluate the use based on an external, evidence-based standard, and most studies did not evaluate individual herbs. Previous studies have reported that people use herbal supplements to promote generalhealth21, 22, 23 and to treat or prevent

CONCLUSION

With the exception of echinacea and ginseng, two thirds of respondents did not use commonly consumed herbs in consonance with a scientific standard. These results suggest that physicians, pharmacists, and other health care professionals should proactively educate consumers and advocate public health policies that would disseminate evidence-based information on the appropriate use of herbs. Further research is needed to confirm the study findings and evaluate mechanisms that enhance

REFERENCES (39)

MJ Slesinski et al.
Trends in use of vitamin and mineral supplements in the United States: the 1987 and 1992 National Health Interview Surveys
J Am Diet Assoc
(1995)
AE Millen et al.
Use of vitamin, mineral, nonvitamin, and nonmineral supplements in the United States: the 1987, 1992, and 2000 National Health Interview Survey results
J Am Diet Assoc
(2004)
ML Neuhouser
Dietary supplement use by American women: challenges in assessing patterns of use, motives and costs
J Nutr
(2003)
M Conner et al.
Why do women use dietary supplements? the use of the theory of planned behaviour to explore beliefs about their use
Soc Sci Med
(2001)
JE Perkin et al.
Prevalence of nonvitamin, nonmineral supplement usage among university students
J Am Diet Assoc
(2002)
LC Paramore
Use of alternative therapies: estimates from the 1994 Robert Wood Johnson Foundation National Access to Care Survey
J Pain Symptom Manage
(1997)
M Conner et al.
Environmental influences: factors influencing a woman's decision to use dietary supplements
J Nutr
(2003)
J Satia-Abouta et al.
Dietary supplement use and medical conditions: the VITAL study
Am J Prev Med
(2003)
K Honda et al.
Use of complementary and alternative medicine among United States adults: the influences of personality, coping strategies, and social support
Prev Med
(2005)
D Fennell
Determinants of supplement usage
Prev Med
(2004)

S Gunther et al.

Demographic and health-related correlates of herbal and specialty supplement use

J Am Diet Assoc

(2004)

DM Eisenberg et al.

Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey

JAMA

(1998)

PM Barnes et al.

Complementary and Alternative Medicine Use Among Adults: United States, 2002

(2004)

JP Kelly et al.

Recent trends in use of herbal and other natural products

Arch Intern Med

(2005)

G Gugliotta

Health concerns grow over herbal aids: as industry booms, analysis suggests rising toll in illness and death

Washington Post

(March 19, 2000)

Natural Marketing Institute

The 2005 Health & Wellness Trends Report: Dietary Supplements

(2005)

Dietary Supplement Health and Education Act of 1994. Pub L No. 103-417, Stat 4325 (codified at USC §301...

G Pinn

Adverse effects associated with herbal medicine

Aust Fam Physician

(2001)

J Barnes et al.

Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: face-to-face interviews with 515 users of herbal remedies

Br J Clin Pharmacol

(1998)

Cited by (107)

Traditional ethnobotanical knowledge and ethnomedicinal use of plants in the Tropical Rift Valley of Ethiopia
2024, Heliyon
A wide range of floral resources are used in Ethiopia for primary healthcare. Unfortunately, due to inadequate documentation and the fact that they were verbally passed down from one generation to the next, these indigenous medicinal practices are being forgotten. The study's goal was to identify and record indigenous peoples' traditional knowledge of plant usage in the Abala Abaya District of Wolaita, Ethiopia.
The collection of ethnobotanical data used a cross-sectional research design involving focus group discussions and semistructured questionnaires between January 2021 and April 2022. From each selected kebele (ward; smallest administrative unit), 50 informants (a total of 200) were selected as representative sample using a systematic random sampling technique.
More than 50 different human and animal illnesses have been documented to be treated by seventy-two species of plants grouped in thirty-two families. The most abundant families were Poaceae and Asteraceae (8 taxa in each). The two most often used plant parts were leaf (29%) and herbs (54%), respectively. Oral administration was the most typical mode of delivery (75%). For treating stomachache in the category of gastrointestinal illnesses, Hagenia abyssinica (Bruce) J.F.Gmel got the greatest fidelity level scores (FL = 100%).
In Abala Abaya District, there is broad access to traditional medicinal plants that can treat ailments in both humans and animals. This study, therefore, might be a baseline piece of information for further botanical related studies in the region. Plants with the highest FL values are highly recommended for novel drug discovery.
Therapeutic effects of Chinese herbal medicines for treatment of urolithiasis: A review
2023, Chinese Herbal Medicines
Urolithiasis is a common and complex disease of the urinary system, which can cause urinary tract blockage, urinary tract infection, and even damage to urinary system-related tissues. Although urolithiasis can be cured, its high recurrence rate and the development of chronic kidney disease in some patients have drawn the attention of nephrologists. Although the application of extracorporeal lithotripsy, percutaneous nephrolithotomy and other minimally invasive techniques have made the treatment of urolithiasis more efficient, pharmacotherapy plays an indispensable role in reducing their morbidity and recurrence rates. Traditional Chinese medicine (TCM) has been used for treatment and prevention of urolithiasis in developing countries for centuries, known for its unquestionable efficacy and safety. This article reviews the progress of clinical trials and pharmacological studies on the treatment of urolithiasis with Chinese herbal medicines (CHMs). The mechanism of CHMs in the treatment of urolithiasis mainly involve preventing further growth and aggregation of urolithiasis, reducing the PH of urine, promoting calculus dissolution. Furthermore, some CHMs can increase urine output, relax smooth muscles, and promote the removal of calculus. These findings provide new treatment strategies and options for urolithiasis and secondary kidney damage.
The global regulatory framework for medicinal plants
2023, Pharmacognosy: Fundamentals, Applications, and Strategies, Second Edition
This 2022 updated chapter provides an overview of the regulations applicable to commercial medicinal plant products from a global perspective. It explores the underlying reasons for regulation, including the prevalence of medicinal plant use in developing countries, the rapidly growing demand for plant-based medicinal products in more developed countries, and the challenges posed for ensuring both patient safety and choice. The chapter also provides an overview of existing regulatory frameworks and categories, a comparison of the current regulations at a national and regional level, the major role being played by the World Health Organization, and the significant challenges which remain to achieving regional, and ultimately international, harmonization.
Exploring chronic airways disease patients’ perspectives on self-management topics
2022, Patient Education and Counseling
In this study, we explored chronic airways disease (CAD) patients' responses to health literacy (HL) communication domain questions within disease self-management scenarios, as part of a larger CAD HL measurement tool development study.
Adult asthma and chronic obstructive pulmonary disease (COPD) patients from specialty care respiratory clinics were initially presented with realistic disease management scenarios and asked to share information they would communicate. Participants’ responses were grouped into response categories that were reviewed and verified by key informants. A new cohort of CAD patients then responded to the same scenarios and had their answers placed into the developed response categories by trained interviewers.
19 initial stage participants' responses informed response categories for the following self-management topics: Inhaler Use (n = 20); Prednisone Use (n = 30); Flu (Influenza) (n = 35); and Weather Forecasting & Air Quality Index (n = 29). 141 participants’ responses were categorised during the second stage.
Specialty care CAD patients displayed an understanding of key information to communicate across disease self-management topic. Our two-step, patient-driven approach may interest researchers investigating health-related communication from patients' perspectives.
Findings may illuminate potential areas to investigate communication gaps among CAD patients; further investigation is warranted among non-specialty care patients.
Cytochrome P450 inhibition activities of non-standardized botanical products
2022, Journal of Ethnopharmacology
Citation Excerpt :
Interestingly, most botanical medicines are used in conjunction with conventional therapy rather than as a replacement (Eisenberg et al., 1993; Enioutina et al., 2017). In the United States, the concurrent use of botanical medicine is reported to be among 20–30% of conventional drug users (Bardia et al., 2007; Bent, 2008) and about 36–38% of patients with cancer after chemotherapy (Engdal et al., 2008; Molassiotis et al., 2005). In some Asian countries such as Taiwan and Korea, a high proportion of patients are simultaneously administering botanical products and prescribed medicine (Chen et al., 2013; Seo et al., 2013; Wang et al., 2014a).
R-tab, H-tab and E-cap botanical products are used for the treatment of various ailments. R-tab is traditionally prescribed for improving urination, H-tab is for relieving piles, hemorrhoids, fissures, and rectal inflammation and E-cap is for regulating menstruation.
Aims of the study: To extract the botanical products and determine their potential interaction with the cytochrome P450 (CYP1A2, CYP2D6 and CYP3A4) enzymes.
R-tab, H-tab and E-cap botanical products were first extracted using solvents and analyzed using HPLC and LC-MS/MS. The effects of methanol extracts on the cytochrome induction and inhibition activities were determined using a series of in vitro assays, including multiplex RT-qPCR, CYP activity assays (P450-Glo™) and LC-MS/MS-based assays. For the CYP induction assay, omeprazole, rifampicin and dexamethasone were used as CYP1A2, CYP2D6 and CYP3A4 inducers, respectively. Ketoconazole and acetaminophen were used as positive and negative controls for the CYP3A4 inhibition assay, whereas furafylline and ketoconazole were used as positive and negative controls for the CYP1A2 inhibition assay.
All three botanical products did not show any significant induction in CYP1A2, CYP2D6 and CYP3A4 mRNA expression. By contrast, R-tab inhibited the mRNA expression of CYP1A2 significantly from the lowest concentration of 0.01 μg/mL, while, H-tab inhibited the mRNA expression of CYP1A2 and CYP3A4 from 0.1 μg/mL. Based on the P450 Glo assays, E-cap extract inhibited the metabolic activity of CYP1A2 with an IC₅₀ value of 37.24 μg/mL. On the other hand, R-tab, H-tab and E-cap showed inhibitory effects on the CYP3A4 enzymatic activity with IC₅₀ values of 17.42, 18.20 and 20.60 μg/mL, respectively. However, using the LC-MS/MS-based methods, the concentration-dependent effects of R-tab and H-tab extracts on the metabolism of testosterone appeared to be more prominent, with IC₅₀ values of 51.90 and 56.90 μg/mL as compared with the rest of the results, which were all above 100 μg/mL
The CYP3A4 mRNA and enzymatic activity were moderately inhibited by R-tab and H-tab. Methanol extract of botanical products in solid dosage forms can be evaluated for their herb-drug interaction risks using in vitro assays and may provide the minimum data required for safety labeling.
Traditional Chinese medicine-associated nephrotoxicity and the importance of herbal interactions – An overview
2022, Pharmacological Research - Modern Chinese Medicine
Herbal traditional Chinese medicines (TCMs) are an increasingly popular alternative therapy globally. Due to the complex chemical composition of herbal products, and with research showing that consumers from Western countries are more likely to take multiple herbal products at one time, the lack of understanding of the potential side effects of herbal TCM may pose a significant risk to health and wellbeing. This may be particularly so now that herbal preparations are being promoted for the prevention and treatment of COVID-19 symptoms, often in association with Western medicines such as paracetamol. Of interest are the potential adverse effects of herbal TCMs on the kidney. Many factors can lead to the development of renal injury including intrinsic toxicity, plant misidentification, adulteration, contamination, and of increasing importance, interactions with conventional drugs and other herbs. This review evaluates and summarizes some of the key aspects of TCM-induced nephrotoxicity and the current scope of herb-drug and herb-herb interaction that may cause adverse effects.

View all citing articles on Scopus

: This work was made possible by grant P01 ES012020 from the National Institute of Environmental Health Sciences and the Office of Dietary Supplements, National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Environmental Health Sciences, National Institutes of Health.

View full text

ORIGINAL ARTICLEUse of Herbs Among Adults Based on Evidence-Based Indications: Findings From the National Health Interview Survey

OBJECTIVE

PARTICIPANTS AND METHODS

RESULTS

CONCLUSION

Section snippets

PARTICIPANTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

J Am Diet Assoc

J Am Diet Assoc

J Nutr

Soc Sci Med

J Am Diet Assoc

J Pain Symptom Manage

J Nutr

Am J Prev Med

Prev Med

Prev Med

J Am Diet Assoc

Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey

JAMA

Complementary and Alternative Medicine Use Among Adults: United States, 2002

Recent trends in use of herbal and other natural products

Arch Intern Med

Health concerns grow over herbal aids: as industry booms, analysis suggests rising toll in illness and death

Washington Post

The 2005 Health & Wellness Trends Report: Dietary Supplements

Adverse effects associated with herbal medicine

Aust Fam Physician

Different standards for reporting ADRs to herbal remedies and conventional OTC medicines: face-to-face interviews with 515 users of herbal remedies

Br J Clin Pharmacol

ORIGINAL ARTICLE
Use of Herbs Among Adults Based on Evidence-Based Indications: Findings From the National Health Interview Survey