Dietary Supplements

What is a "Dietary Supplement"? The U.S. Food and Drug Administration (FDA) defines dietary supplement as a product people use in addition to the foods they eat. This would include herbals, vitamins, minerals and other products. Since Dietary Supplements are considered food by the FDA, they do not require the manufacturer to prove safety or effectiveness. Be aware that, while some supplements may be good for you, others may cause you harm.

A recent survey discovered that most people do not inform their prescribing practitioner when they are taking a supplement. Combining herbals with medicines can result in an adverse reaction where "double–dosing" can occur or a worsening of symptoms in those with a chronic medical condition. That is why it is important to use caution when taking supplements. It is always best to discuss use of an herbal or supplement with your doctor or prescribing practitioner before starting it.

Herbals

The use of herbals is on the rise. Some of the fastest growing herbal categories include the following:

Herbals that increase circulation (e.g. ginko biloba, gotu kola),
Herbals used for calmative effect (e.g. kava kava, valerian, chamomile, scullcap),
Herbals to lessen a cold/ flu symptoms and boost immunity (e.g. echinacea, goldenseal, astaulas, pau d'arco),
Men's herbs (e.g. saw palmetto, pygeum),
Herbs for mild depression (e.g. St. John's Wort).

Be Careful When Using Herbal Supplements

Herbals can interact with drugs used for anesthesia. The American Society of Anesthesiologists recommends that all herbals be discontined 2-3 weeks prior to a scheduled surgery.
Herbals can adversely affect a pregnancy. Stop all herbals if pregnant or breast-feeding.
Many herbals can interact with the anticoagulant Coumadin® (also called warfarin). Some herbs can have an affect on how long it takes your blood to clot. Avoid taking supplements of garlic, ginko biloba, ginger, feverfew, dong quai or teas with coumarin while taking the blood thinner Coumadin® as these herbs can further prolong clotting times. Avoid goldenseal as this herb can shorten clotting time. This may not be a complete list of interactions. More study is needed. Check with your pharmacist and/or healthcare practitioner before deciding to take any herbal product while on Coumadin®.
Don't give herbal remedies to children without first checking with the child's pediatrician. There are many unknowns about the affect of herbs on children.
Don't take herbal products containing ephedra. Many deaths have been associated with its use.
Many drugs interact with St. John's Wort, prompting the US Food and Drug Administration to issue a health advisory. The FDA advises against using St. John's Wort if also taking any one of 50 other medications. St. John's Wort can cause some drugs to be eliminated from the body too quickly, making them less effective. This includes oral contraceptives, anti-cancer agents, heart medications and drugs that fight HIV. For a complete list of affected medications, go to www.fda.gov/cder/drug/advisory/stjwort.htm
Ask merchants about standardization of a product and names of reputable manufacturers. Check label for “dosage” which can vary depending upon the strength of the product and the condition you are treating or preventing.
Know that combined use of herbs with medicines can have an unpredictable, synergistic effect. Just because a product is “Natural” doesn't mean it's “Safe”. Keep a list of medicines and supplements you take and always share this information with prescribing practitioners and your pharmacist. Communication is key to safer use of medicines and herbal supplements!

If you require more information about herbals, consult with your doctor, nurse or pharmacist or the company that manufacturers the product. Below is a list of popular herbal supplements, common uses, possible reactions and precautions to take.

POPULAR HERBAL SUPPLEMENTS

Herb/
Scientific
Name Common
Uses Body of
Evidence Possible
Reactions Additional
Precautions/
Comments

Astragalus/
Astragalus membranaceus To enhance immune system functioning and improve endurance Increases natural killer cells for cancer patients and for HIV patients. Polysacha rides are probably effective component. It decreases blood pressure due to vasodilation. It also has a prolonged diuretic effect.

Black Cohash/,br> Cimicifuga racemosa Treatment of PMS and perimenopause discomfort 8 studies concluded this herb can increase energy, improve mood and control hot flashes. Can cause upset stomach, weight gain, headaches. Use with caution if you have high blood pressure Long-term safety is not known. Limit use to no more than six months.

Chamomile/
Chamomilla recutita nti-inflammatory. Antispasmodic. Sedative. Antiulcer. Dried flower heads are used as a tea 3 or more times a day to promote relaxation.

Dong Quai/
Anelica sinemsis Relief of menopause symptoms and PMS A recent study found dong quai root, if used alone, was not helpful. It is generally used with other herbs like black cohash. Reacts with blood thinning agents like Coumadin or Heparin, prolonging bleeding times. Vasodilatory and anti-spasmodic effect. Do NOT use in conjunction with anti-coagulant therapy. Do NOT use with any bleeding disorder.

Echinacea/
Anusctifolia, palida or purpurea To relieve upper-respiratory infections like colds, flu, bronchitis. Echinacea purpurea may help shorten the length of a cold but it does not prevent it. Used topically, it can hasten wound healing with herpes simplex or eczema. Limit use to 8 weeks. Longterm use may actually suppress the immune system so long-term use is not advised. NOT to be used in systemic disease (TB, Leukosis, collagenosis, MS, HIV, AIDS)

Evening Primrose/
Oenothera biennis To lower cholesterol. To reduce arthritis inflammation. To reduce breast swelling with PMS. To treat MS Has gamma linoleic acid which has been shown to lower cholesterol. Can accentuate schizophrenic episodes or precipitate seizure in those taking epileptogenic drugs. NOT recommended for patients with schizophrenia or for those on drugs to treat seizure disorder.

Feverfew/
Tanacetum parthenium To prevent migraine headaches Studies vary from 70% reporting reduction in migraine severity to others having no relief at all. Stomach upset, mouth ulcers. Feverfew can interfere with blood clotting. Do NOT use with antiocoagulant therapy or with any bleeding disorder. May cause rebound headache. Does not relieve migraine once it occurs.

Flax seed/
Linum usitatissimum To promote a healthy immune system. To provide fiber. To control menopause symptoms i.e. night sweats. Contains alpha-linoleic acid (ALA) - an essential omega-3 fatty acid. Plant lignans increase production of sex hormone binding globulin. Affects vasoconstriction and vasodilation Drink plenty of water with this food as it can be binding. Contraindicated in bowel obstruction or patient with prostate cancer. Product must be fresh due to high rate of oxidation. Avoid concurrent use with laxative. Avoid taking w/ oral medicines - diminishes drug's effect

Garlic/
Allium sativum To lower blood pressure.To lower cholesterol. Study results are inconsistent in garlic's abilty to lower cholesterol. Can mildly lower blood pressure. Can interfere with hypoglycemic therapy (used in diabetes) and with anticoagulant therapies. Other side effects include nausea, vomiting and diarrhea and a burning sensation in the mouth. Do NOT use in conjunction with anti-coagulant therapy or anti-diabetic therapy without consulting your doctor. Do not use with any bleeding disorder.

Ginger/
Zingiber-officinale To relieve motion sickness or nausea; To inhibit platelet aggregation; Cardiotonic effect; To lower cholesterol. Some antibiotic action. Antioxidant Studies conflict as to effectiveness as anti-nausea remedy but many claim it works like dramamine to fight motion sickness without the side-effects. Herbalists believe ginger is a potent stomach soother. Effects gallbladder. May interfere with existing cardiac, antidiabetic or anticoagulant therapy. Do NOT use with anticoagulant therapy or bleeding disorder. Check with your doctor if being treated for diabetes or a cardiac condition. Fresh ginger root has safe class 1 rating. Dried root is Class 2 rating - not be used by persons with gallstones.

Ginko/
Ginkgo biloba To enhance memory and slow dementia. To improve distance walking. To improve circulation especially to the brain. Has been shown to help people with mild Alzheimer's but unclear whether it improves memory in healthy people. Can reduce swelling in hands and feet. Evidence of improved eyesight in conditions related to aging. Stomach upset, headache. Allergic skin reaction. Consult with your doctor if taking blood thinners including aspirin and ibuprofen. Use with caution with any anticoagulant and antiplatelet medicines. Ginko can interact with MAO inhibitors - be careful!

Ginseng/
Panax To have a cardiotonic effect. To help regulate blood sugar. To invigorate. Has been shown to be useful in treatment of breast cancer patients - during convalescence, physical or mental exhaustion, stress, inadequate resistance to infections. Potentiates many other drug actions(synergistic effect) including estrogens and steroids Contraindicated for individuals with high blood pressure, acute illness, those taking stimulants or antipsychotic drugs. Can interact with phenelzine. Use with doctor's supervision only if hypoglycemic or in diabetes to help regulate blood sugar. Do NOT use with anticoagulant therapy. Ginseng is from a plant that's hard to grow and expensive. It takes 5 years for the root to have herbal benefit. Look for at least 4% potency. There are many types of ginseng. The leaf is cheaper but ineffective.

Goldenseal/
Hydrastis canadensis To decrease mucosal inflammation. Effect on wide variety of ailments that affect mucous membrane lining: decreases upper respiratory symptoms with cold or flu, decreases gastritis, decreases painful menstruation, decreases atonic dyspepsia. Contraindicated in those with high blood pressure. May oppose action of heparin. Do NOT use with high blood pressure. Do NOT use with heparin as has coagulant activity that opposes action of heparin.Sometimes used as a topical eye wash but consult with your doctor before using in this manner.

Gotu Kola/
Cenetella asiatica To improve memory. To treat venous insufficiency. To overcome fatigue, stress, mental confusion. Has been shown to have other actions including anti-inflammatory, diuretic, digestant, CNS depressant, laxative, antipyretic. It increases the development and maintenance of blood vessels and connective tissue. Can improve wound healing if used topically. Contraindicated in epilepsy. Side effects include contact dermatitis and sensitivity to light. Do NOT use with anti-diabetic drugs or cholesterol lowering drugs. Gotu Kola is a plant that elephants eat a lot of... and everyone knows that an elephant never forgets.

Grape seed extract/
Pine Bark Antioxidant. To improve capillary resistance with varicose veins, cirrhosis of liver, ischemia, retinopathy. Anti-inflammatory. Contain OPCs (Oligomeric Proantho Cyanidins) which are located in the skin and seeds of grapes. OPCs are unique in that they have property of antioxidant in both lipid and aqueous phases.Effective free radical quencher for both positve and negative charge Antioxidant capacity 50 times greater than Vit E and 20 times greater than Vit C. Good source of flavonoids. Flavonoids are the most powerful antioxidants found today.

Green Tea/
Camellia Sinensis To protect against chemically induced tumor initiation or promotion. Antioxidant-lowers cholesterol. mild stimulant. Contains good antioxidant effects with vitamins C & E. Drink 3 cups per day to decrease cancer risk. Inhibits effects of ultraviolet rays. Blocks formation nitrosamine. Used to prevent athersclerosis and hypercholesterolemia. Contraindicated in persons who are sensitive to stimulants.

Kava-Kava/
piper methysticum For nervous anxiety, stress and restlessness. Used to enhance sleep Useful with skeletal muscle spasm and tension. Kava-Kava treats mild insomnia conditions. It is also useful as an anesthetic on mucous membranes to control pain in oral conditions. Topical antifungal. Analgesic. Potentiates many other drugs (synergistic). Contraindicated in endogenous depression. Can cause mild GI distrubances. Extended use can temporarily cause yellow coloration skin, hair and nails. Kava-Kava (Piper methysticum) has a Class 2d Botanical Rating which means restrictions apply. Avoid use with alcohol and/or if taking other medicines prescribed by a doctor. Do not use for more than 3 months without medical advice.

Scullcap/
Scutellaria laterifolia To reduce stress (nervine tonic); Anti-spasmodic; Hypotensive Used for many years in Soviet Union. Used by soldiers, deep sea divers, rescue people exposed to extreme weather and stress. Overconsumption has been shown to cause CNS stimulation, irregular pulse, confusion and hyper-reflexia, but, no fatal toxicity has been found. Root is most important part of plant.

Soy
Isoflavones To prevent osteoporosis. To stimulate mineralization of bone. To regulate calcium storage within cell. Estrogen modulator Soy isoflavones can regulate calcium exchange across the cell membrane and calcium storage. May play a role in prevention of atherosclerotic lesions. Natural plant estrogens help modulate estrogen in the body. May help prevent breast cancer. Not to be used in conjunction with tamoxifen therapy. NEW: Benecol margarine made from soy and other oils, claims to lower blood cholesterol. No known negative reactions. Used in Europe for many years. Expensive ($14.98/lb). Natural soy products have the same protective benefit against osteoporosis as taking soy isoflavones supplement. Foods like soy puddings, soy nuts, soymilk, tofu and other foods made from soybeans are all beneficial. High in plant estrogens.

St. John's Wort/
Hypericum perforatum To treat mild depression. Has Antibacterial, Antifungal properties. St. John’s Wort is from Hypericum perforatum. It is an anti-depressant psychotropic. Affects mood and behavior. Potentiates many other drug actions (synergistic). Increased sensitivity to light if taken in high doses. Can potentiate MAO inhibitors. Interacts with other medicines especially alcohol and over-the-counter cold and flu meds Since St. John's Wort affects brain chemistry and since long-term effects are not known, it is recommended that its use be limited to no longer than 3 weeks. Hastens elimination of many drugs, rendering them ineffective - including heart medicines, anti-cancer agents, drugs to fight HIV and birth control pills. For a complete list of affected medicines, go to www.fda.gov/cder/drug/advisory/stjwort.htm

Valerian/
Valerian officinalis To relieve insomnia and/or anxiety Studies have shown it produces less grogginess in some people than prescription sleep aids do. Blocks arousal centers of brain. Headaches, restlessness. Valerian root is not associated with dependence and potential addiction - safer to use long-term Do not take before driving. Don't use with other sedatives. Do not use with alcohol - potentiates its effect. Valerian has a bad odor.

Herb/ Scientific Name	Common Uses	Body of Evidence	Possible Reactions	Additional Precautions/ Comments
Astragalus/ Astragalus membranaceus	To enhance immune system functioning and improve endurance	Increases natural killer cells for cancer patients and for HIV patients. Polysacha rides are probably effective component.	It decreases blood pressure due to vasodilation. It also has a prolonged diuretic effect.
Black Cohash/,br> Cimicifuga racemosa	Treatment of PMS and perimenopause discomfort	8 studies concluded this herb can increase energy, improve mood and control hot flashes.	Can cause upset stomach, weight gain, headaches. Use with caution if you have high blood pressure	Long-term safety is not known. Limit use to no more than six months.
Chamomile/ Chamomilla recutita	nti-inflammatory. Antispasmodic. Sedative. Antiulcer.	Dried flower heads are used as a tea 3 or more times a day to promote relaxation.
Dong Quai/ Anelica sinemsis	Relief of menopause symptoms and PMS	A recent study found dong quai root, if used alone, was not helpful. It is generally used with other herbs like black cohash.	Reacts with blood thinning agents like Coumadin or Heparin, prolonging bleeding times. Vasodilatory and anti-spasmodic effect.	Do NOT use in conjunction with anti-coagulant therapy. Do NOT use with any bleeding disorder.
Echinacea/ Anusctifolia, palida or purpurea	To relieve upper-respiratory infections like colds, flu, bronchitis.	Echinacea purpurea may help shorten the length of a cold but it does not prevent it. Used topically, it can hasten wound healing with herpes simplex or eczema.	Limit use to 8 weeks. Longterm use may actually suppress the immune system so long-term use is not advised.	NOT to be used in systemic disease (TB, Leukosis, collagenosis, MS, HIV, AIDS)
Evening Primrose/ Oenothera biennis	To lower cholesterol. To reduce arthritis inflammation. To reduce breast swelling with PMS. To treat MS	Has gamma linoleic acid which has been shown to lower cholesterol.	Can accentuate schizophrenic episodes or precipitate seizure in those taking epileptogenic drugs.	NOT recommended for patients with schizophrenia or for those on drugs to treat seizure disorder.
Feverfew/ Tanacetum parthenium	To prevent migraine headaches	Studies vary from 70% reporting reduction in migraine severity to others having no relief at all.	Stomach upset, mouth ulcers. Feverfew can interfere with blood clotting.	Do NOT use with antiocoagulant therapy or with any bleeding disorder. May cause rebound headache. Does not relieve migraine once it occurs.
Flax seed/ Linum usitatissimum	To promote a healthy immune system. To provide fiber. To control menopause symptoms i.e. night sweats.	Contains alpha-linoleic acid (ALA) - an essential omega-3 fatty acid. Plant lignans increase production of sex hormone binding globulin. Affects vasoconstriction and vasodilation	Drink plenty of water with this food as it can be binding. Contraindicated in bowel obstruction or patient with prostate cancer.	Product must be fresh due to high rate of oxidation. Avoid concurrent use with laxative. Avoid taking w/ oral medicines - diminishes drug's effect
Garlic/ Allium sativum	To lower blood pressure.To lower cholesterol.	Study results are inconsistent in garlic's abilty to lower cholesterol. Can mildly lower blood pressure.	Can interfere with hypoglycemic therapy (used in diabetes) and with anticoagulant therapies. Other side effects include nausea, vomiting and diarrhea and a burning sensation in the mouth.	Do NOT use in conjunction with anti-coagulant therapy or anti-diabetic therapy without consulting your doctor. Do not use with any bleeding disorder.
Ginger/ Zingiber-officinale	To relieve motion sickness or nausea; To inhibit platelet aggregation; Cardiotonic effect; To lower cholesterol. Some antibiotic action. Antioxidant	Studies conflict as to effectiveness as anti-nausea remedy but many claim it works like dramamine to fight motion sickness without the side-effects. Herbalists believe ginger is a potent stomach soother. Effects gallbladder.	May interfere with existing cardiac, antidiabetic or anticoagulant therapy.	Do NOT use with anticoagulant therapy or bleeding disorder. Check with your doctor if being treated for diabetes or a cardiac condition. Fresh ginger root has safe class 1 rating. Dried root is Class 2 rating - not be used by persons with gallstones.
Ginko/ Ginkgo biloba	To enhance memory and slow dementia. To improve distance walking. To improve circulation especially to the brain.	Has been shown to help people with mild Alzheimer's but unclear whether it improves memory in healthy people. Can reduce swelling in hands and feet. Evidence of improved eyesight in conditions related to aging.	Stomach upset, headache. Allergic skin reaction.	Consult with your doctor if taking blood thinners including aspirin and ibuprofen. Use with caution with any anticoagulant and antiplatelet medicines. Ginko can interact with MAO inhibitors - be careful!
Ginseng/ Panax	To have a cardiotonic effect. To help regulate blood sugar. To invigorate.	Has been shown to be useful in treatment of breast cancer patients - during convalescence, physical or mental exhaustion, stress, inadequate resistance to infections. Potentiates many other drug actions(synergistic effect) including estrogens and steroids	Contraindicated for individuals with high blood pressure, acute illness, those taking stimulants or antipsychotic drugs. Can interact with phenelzine. Use with doctor's supervision only if hypoglycemic or in diabetes to help regulate blood sugar.	Do NOT use with anticoagulant therapy. Ginseng is from a plant that's hard to grow and expensive. It takes 5 years for the root to have herbal benefit. Look for at least 4% potency. There are many types of ginseng. The leaf is cheaper but ineffective.
Goldenseal/ Hydrastis canadensis	To decrease mucosal inflammation.	Effect on wide variety of ailments that affect mucous membrane lining: decreases upper respiratory symptoms with cold or flu, decreases gastritis, decreases painful menstruation, decreases atonic dyspepsia.	Contraindicated in those with high blood pressure. May oppose action of heparin.	Do NOT use with high blood pressure. Do NOT use with heparin as has coagulant activity that opposes action of heparin.Sometimes used as a topical eye wash but consult with your doctor before using in this manner.
Gotu Kola/ Cenetella asiatica	To improve memory. To treat venous insufficiency. To overcome fatigue, stress, mental confusion.	Has been shown to have other actions including anti-inflammatory, diuretic, digestant, CNS depressant, laxative, antipyretic. It increases the development and maintenance of blood vessels and connective tissue. Can improve wound healing if used topically.	Contraindicated in epilepsy. Side effects include contact dermatitis and sensitivity to light. Do NOT use with anti-diabetic drugs or cholesterol lowering drugs.	Gotu Kola is a plant that elephants eat a lot of... and everyone knows that an elephant never forgets.
Grape seed extract/ Pine Bark	Antioxidant. To improve capillary resistance with varicose veins, cirrhosis of liver, ischemia, retinopathy. Anti-inflammatory.	Contain OPCs (Oligomeric Proantho Cyanidins) which are located in the skin and seeds of grapes. OPCs are unique in that they have property of antioxidant in both lipid and aqueous phases.Effective free radical quencher for both positve and negative charge	Antioxidant capacity 50 times greater than Vit E and 20 times greater than Vit C. Good source of flavonoids. Flavonoids are the most powerful antioxidants found today.
Green Tea/ Camellia Sinensis	To protect against chemically induced tumor initiation or promotion. Antioxidant-lowers cholesterol. mild stimulant.	Contains good antioxidant effects with vitamins C & E. Drink 3 cups per day to decrease cancer risk. Inhibits effects of ultraviolet rays. Blocks formation nitrosamine. Used to prevent athersclerosis and hypercholesterolemia.	Contraindicated in persons who are sensitive to stimulants.
Kava-Kava/ piper methysticum	For nervous anxiety, stress and restlessness. Used to enhance sleep	Useful with skeletal muscle spasm and tension. Kava-Kava treats mild insomnia conditions. It is also useful as an anesthetic on mucous membranes to control pain in oral conditions. Topical antifungal. Analgesic. Potentiates many other drugs (synergistic).	Contraindicated in endogenous depression. Can cause mild GI distrubances. Extended use can temporarily cause yellow coloration skin, hair and nails.	Kava-Kava (Piper methysticum) has a Class 2d Botanical Rating which means restrictions apply. Avoid use with alcohol and/or if taking other medicines prescribed by a doctor. Do not use for more than 3 months without medical advice.
Scullcap/ Scutellaria laterifolia	To reduce stress (nervine tonic); Anti-spasmodic; Hypotensive	Used for many years in Soviet Union. Used by soldiers, deep sea divers, rescue people exposed to extreme weather and stress.	Overconsumption has been shown to cause CNS stimulation, irregular pulse, confusion and hyper-reflexia, but, no fatal toxicity has been found.	Root is most important part of plant.
Soy Isoflavones	To prevent osteoporosis. To stimulate mineralization of bone. To regulate calcium storage within cell. Estrogen modulator	Soy isoflavones can regulate calcium exchange across the cell membrane and calcium storage. May play a role in prevention of atherosclerotic lesions. Natural plant estrogens help modulate estrogen in the body. May help prevent breast cancer.	Not to be used in conjunction with tamoxifen therapy.	NEW: Benecol margarine made from soy and other oils, claims to lower blood cholesterol. No known negative reactions. Used in Europe for many years. Expensive ($14.98/lb). Natural soy products have the same protective benefit against osteoporosis as taking soy isoflavones supplement. Foods like soy puddings, soy nuts, soymilk, tofu and other foods made from soybeans are all beneficial. High in plant estrogens.
St. John's Wort/ Hypericum perforatum	To treat mild depression. Has Antibacterial, Antifungal properties.	St. John’s Wort is from Hypericum perforatum. It is an anti-depressant psychotropic. Affects mood and behavior. Potentiates many other drug actions (synergistic).	Increased sensitivity to light if taken in high doses. Can potentiate MAO inhibitors. Interacts with other medicines especially alcohol and over-the-counter cold and flu meds	Since St. John's Wort affects brain chemistry and since long-term effects are not known, it is recommended that its use be limited to no longer than 3 weeks. Hastens elimination of many drugs, rendering them ineffective - including heart medicines, anti-cancer agents, drugs to fight HIV and birth control pills. For a complete list of affected medicines, go to www.fda.gov/cder/drug/advisory/stjwort.htm
Valerian/ Valerian officinalis	To relieve insomnia and/or anxiety	Studies have shown it produces less grogginess in some people than prescription sleep aids do. Blocks arousal centers of brain.	Headaches, restlessness. Valerian root is not associated with dependence and potential addiction - safer to use long-term	Do not take before driving. Don't use with other sedatives. Do not use with alcohol - potentiates its effect. Valerian has a bad odor.

Vitamins

Mega-dosing (taking large quantities) of a vitamin can cause ill effects. As a general rule, do not exceed more than 300% of the vitamin's recommended daily allowance (RDA). Mega-dosing can be harmful. Check with your pharmacist about safe vitamin dosages.

When choosing a multivitamin, you can check to see if it will be readily absorbed by placing the vitamin into a glass of white vinegar. It should dissolve in 30 minutes.Coated vitamin tablets usually take longer to absorb. If you decide to take a supplemental multivitamin each day, you should never consider it a replacement for eating a well-balanced diet.

More Research is Needed

Use of natural remedies and dietary supplements is becoming more mainstream. The National Institutes of Health established the Office of Alternative Medicine (OAM) in 1992 to research unconventional therapies. The first five years, the OAM budget has more than quadrupled. Much of what we know or think we know about herbals is based largely on anecdote. As more investigational studies on herbs and other alternative treatments receive funding, our long-held beliefs will be clarified. Always be careful when taking herbals or other dietary supplements and remember that communication with healthcare professionals is key to safer use of medicines and supplements.