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Making Decisions About Herbal Therapies: Choosing Over-the-Counter Herbal Products

Part of A Practical Guide to Herbal Therapies for People Living With HIV


Many people with HIV use the pre-packaged herbal therapies they find in herbal and health food stores and that are becoming increasingly available in drug stores and department stores. They may find that researching and choosing their own therapies lets them feel more in control of their illness. Over-the-counter therapies are also cheaper and generally more available than the individually prepared therapies you might get from an herbal practitioner. If you decide to use pre-packaged therapies, make sure you have properly identified your illness. Although herbal treatments generally have few side effects, delaying the treatment of a serious illness because you have misdiagnosed it can be deadly. This is particularly true for HIV-positive people whose immune function may already be limited by HIV infection. Check with a doctor or another health-care professional about any new symptoms or changes in your health. It's also wise to tell your doctor about any herbal therapies you're using.

Remember that the store where you buy your treatments can be a major source of information. Here are some of the questions to ask yourself when choosing where to buy herbal treatments:

  • Are staff at the store available to answer questions?


  • Are staff consulting herbalists or have they other professional qualifications?

  • Do staff members have the time to answer questions completely and do they try to do so?

  • How does the store decide which product lines to sell?

  • How does the store assess the quality of a product?

  • Am I comfortable with the people in the store?

  • Can I ask them questions without worrying about what they might do with any health information they glean?

  • Do they regularly carry products I want at a price I can afford?

You should be aware that over-the-counter herbal products vary widely, both in terms of content quality and the accuracy of labelling.

Things to Consider

Here are a few things to consider when purchasing over-the-counter herbal preparations:

Does the preparation have a DIN?
DIN stands for drug identification number. If a manufacturer wishes to market an herbal product based on its medicinal effects, the product must be approved as a drug in Canada. This process is time-consuming, expensive and difficult for small manufacturers. In some cases, the allowable label text is difficult to understand. At present, this process is one of the few quality control mechanisms applied to Canadian herbal products. When a DIN appears on the label of an herbal preparation, the product, or at least some components of the product, have been government approved. As part of the approval process, manufacturers must submit material to justify the product's expiry date. The presence of a DIN is, however, no guarantee of the quality of the product and should not be the sole basis for selection.

Does the label say the product was prepared according to GMP?
Good Manufacturing Practice (GMP) encompasses a series of quality control standards that have been established for foods, drugs and medical devices by the American Food and Drug Administration. Many manufacturers in all parts of the world choose to make their products according to these standards to assure their customers that high standards of quality control have been applied. GMP does not apply to all products in the American market.

Is the product of good quality?
To obtain the maximum benefit from an herbal remedy, it is best to choose products that are grown organically.

Does the product meet the new Canadian standards?
The Natural Health Products Directorate, Health Canada, has established a new regulatory framework for all natural health products sold in Canada. For more on this framework, see the section in this guide called Regulation of Natural Health Products.

Does the label tell you about side effects and drug interactions?
Although the producers of herbal therapies can't make claims about the medical benefits of a preparation unless it has been approved as a drug, they can tell you about possible side effects or drug interactions. A manufacturer's decision to include this information on the label suggests a responsible attitude toward the production of medicinal herbs.

Is the label properly glued and clearly printed?
This may sound silly, but it's probably fair to say that a manufacturer that is careless about packaging its product may also be careless about what's inside

Does the label tell you how much product is in each capsule and how much to take?
Since the manufacturer knows more than anyone about the content and potency of its product, such information is useful when deciding what dose to use. This information is also useful when comparing products. Sometimes, inexpensive products will contain as many capsules as more expensive products but include less herb (or less of the primary active ingredient) in each capsule. It may help to bring a pocket calculator to the store to compare competing products. The label should also state how much of the desired principal active ingredient or of each herb is available in each capsule or tablet.

Is the product available in a form you can absorb?
Pills and tablets may be difficult for some people to digest and so are probably not the best option. For some people, suppositories or sublingual forms, which are able to reach the bloodstream without passing through the liver, may be most useful. Tinctures, made using water and alcohol for the extraction, are generally well absorbed.

Is the herb a rare or endangered species?
Some of the plants used to make herbal products are rare, endangered or are not readily available in natural environments. This includes some of the herbs discussed in this guide, such as goldenseal, ginseng and cat's claw. You may want to take this into consideration when choosing an herbal product. Look for products which use cultivated plants, grown in ways that mimic the natural, native environment.

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This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.