Monthly Archives: November 2013

Green Coffee Bean Extract: Helpful or All Hype?

Green Coffee Bean Extract: Helpful or All Hype?
U.S. News & World Report – Health, 08/02/2013

The hype began in September 2012. On his show, Dr. Oz nationally introduced green bean coffee extract as a “fat burner that helps women lose weight.” And as we know, Dr. Oz has a very strong influence on his viewers, so needless to say, the product took off. So what exactly is green coffee bean extract? “Green coffee” refers to the raw or unroasted seeds (beans) of Coffea fruits. In the typical roasting process of coffee beans, a chemical called chlorogenic acid is reduced. It’s this chemical that is thought to be responsible for several health benefits, including weight loss. There have been several short–term studies suggesting that chlorogenic acid slows absorption of fat from food intake and activates metabolism of extra fat. one of the important things to remember with green coffee bean is that it contains caffeine, just like roasted coffee. And even though two cups of coffee per day is generally safe and might even have its own benefits, more is not better. Excess caffeine can cause insomnia, nervousness and restlessness, gastrointestinal distress, increased heart rate and more. Weight loss takes time and commitment.

Schoolies Week-What are we thinking!

Ever since migrating to Australia, I have been amazed as to why the adults allow schoolies week. Surely it does great harm to many vulnerable adolescents. And yet we seem powerless to stop it. As a society we take great steps to protect our children from harm, yet let them get away with this destructive behaviour, with potential long-term consequences.
27 November 2013, 6.06am AEST

Schoolies week: bad for the body, bad for the brain

In far-flung tourist destinations across Australia and overseas, people are managing and mopping up schoolies week, where secondary school graduates engage in a ritual of excessive alcohol consumption. This cultural normalisation of teen drinking is at odds with preventative health policies that seek…

Few teen drinkers consider the harmful effects of alcohol on their developing brains. Flickr/Lost Albatross

In far-flung tourist destinations across Australia and overseas, people are managing and mopping up schoolies week, where secondary school graduates engage in a ritual of excessive alcohol consumption.

This cultural normalisation of teen drinking is at odds with preventative health policies that seek to reduce adolescent alcohol use and its harm to the developing brain.

Indeed, excessive alcohol use is one of three targets (together with tobacco use and obesity) that Australia has set a priority to prevent because of the cost and suffering it exacts on our nation.

But by their last year of secondary school (around age 17), the majority of Australian students (59% in 2011) report regular use of alcohol on at least a monthly basis.

Alcohol and the developing brain

The brain doesn’t fully mature until a person reaches their mid-20s. So adolescents drinking the same amounts as adults experience greater neurological changes and harms than older drinkers.

The adolescent brain also develops a tolerance to alcohol more rapidly than the adult brain.

This increased tolerance means that young people are able to drink larger amounts without succumbing to alcohol’s sedative effects, increasing the risk of alcohol dependence disorder later in life. With alcohol dependence disorder, alcohol tolerance has progressed to such an extent that a daily dose of alcohol is required to avoid withdrawal symptoms such as shakes, seizures or death.

Although young people can develop a tolerance to frequent and heavy use of alcohol, this doesn’t protect the adolescent brain from alcohol’s harmful effects.

Chronic adolescent alcohol misuse has been found to disrupt the frontal cortex and mid brain areas that contribute to memory and cognitive abilities that assist problem solving, visual memory and self-regulation, with increased vulnerability to the toxic effects of alcohol continuing until the mid-20s.

Heavy adolescent drinkers are at risk of problems that include: traumatic assault and injury, violence, and drinking heavily in pregnancy which can pass on foetal alcohol syndrome and symptoms to Australia’s next generation.

Breaking the habit

Increasing the price of alcohol and the level of regulations governing its sale and marketing, would help to reduce alcohol use problems across the Australian population.

Raising the legal age for purchasing alcohol from 18 to 21 would be very effective in reducing youth alcohol consumption.

In states that have raised the legal purchase age, parents and young people have received a clear message that adolescent alcohol use is harmful and youth alcohol problems have reduced.

And without changing the legal age, it is possible to effectively encourage young people to delay drinking until they reach the legal drinking age of 18, by reducing the supply of alcohol.

Parents are the major suppliers of alcohol to early adolescents. In a recently published study of more than 2,000 students from 24 disadvantaged secondary schools, our team demonstrated a 25% reduction in binge drinking in a two-year period. This was achieved by providing information to parents that discouraged them from supplying, supervising or allowing adolescent alcohol use.

Our team have also trialled a novel strategy to significantly reduce underage alcohol sales by implementing sales monitoring checks.

In 2012, underage sales practices were checked in over 300 bottle shops across 30 Australian communities. The majority sold alcohol to youth that looked underage.

We provided feedback regarding staff behaviour to the management of half of the outlets. When the checks were repeated in 2013, we found the feedback had resulted in significant reductions in the sale of alcohol to underage youth.

There are a number of effective strategies that can prevent adolescent alcohol use and related problems. These typically involve changing specific cultural factors such as laws and parent and community practices to reduce the supply of alcohol to young people.

We now have considerable scientific understanding of the effective policies. The next step will require national will to implement these effective prevention policies at a scale that can change our culture of harmful alcohol use.

Reducing Wrinkles

Wrinkle reduction in post-menopausal women consuming a novel oral supplement: a double-blind placebo-controlled randomised study
International Journal of Cosmetic Science, 08/09/2013  Evidence Based Medicine  Clinical Article

Jenkins G et al. – The aim of the present study was therefore to evaluate the effect on skin wrinkling, of a combination of ingredients reported to influence key factors involved in skin ageing; namely inflammation, collagen synthesis and oxidative/UV stress. A supplemented drink was developed containing soy isoflavones, lycopene, vitamin C and vitamin E and given to post–menopausal women with a capsule containing fish oil. This study demonstrates that consumption of a mixture of soy isoflavones, lycopene, vitamin C, vitamin E and fish oil is able to induce a clinically measureable improvement in the depth of facial wrinkles following long term use.


  • Authors have performed a double–blind randomised controlled human clinical study to assess whether this cocktail of dietary ingredients can significantly improve the appearance of facial wrinkles.


  • Authors have shown that this unique combination of micronutrients can significantly reduce the depth of facial wrinkles and that this improvement is associated with increased deposition of new collagen fibres in the dermis.

Circulation in the brain linked to dementia

11 July 2013, 2.00pm EST

Circulation in the brain linked to dementia

Cerebrovascular disease, which affects circulation of blood in the brain, is significantly associated with dementia, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.

The researchers analysed 5,715 cases from the National Alzheimer’s Coordinating Center (NACC) database, which have been collected from across the United States since the launch of the NACC in 1999.

The finding suggests that early management of vascular risk factors, such as high blood pressure and cholesterol, and adopting a “heart healthy” diet, as well as exercise and other aspects of mid-life lifestyles may delay or prevent the onset of dementia due to Alzheimer’s and Parkinson’s disease.

Oestrogen in severe mental illness.

Arch Gen Psychiatry. 2008 Aug;65(8):955-60. doi: 10.1001/archpsyc.65.8.955.

Estrogen in severe mental illness: a potential new treatment approach.


Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychology, Psychiatry, and Psychological Medicine, The Alfred Hospital, Melbourne, Victoria 3004, Australia.



Accumulating evidence suggests that estrogens may have therapeutic effects in severe mental illnesses, including schizophrenia, via neuromodulatory and neuroprotective activity.


To compare the efficacy of adjunctive transdermal estradiol with that of adjunctive placebo in the treatment of acute psychotic symptoms.


Randomized, double-blind study.


Patients were recruited from inpatient acute hospital wards and outpatient clinics of 2 metropolitan Melbourne general hospitals.


One hundred two women of childbearing age with schizophrenia. All participants were in an acute or chronic phase of their illness; 73 participants were outpatients and the rest were inpatients. Intervention Patients were randomized to receive 100 microg of transdermal estradiol (n = 56) or transdermal placebo (n = 46) for 28 days.


Psychopathological symptoms were assessed weekly with the Positive and Negative Syndrome Scale.


The addition of 100 microg of transdermal estradiol significantly reduced positive (P < .05) and general psychopathological (P < .05) symptoms during the 28-day trial period compared with women receiving antipsychotic medication alone.


Estradiol appears to be a useful treatment for women with schizophrenia and may provide a new adjunctive therapeutic option for severe mental illness.

A Glut of Antidepressants

I come across many people(mainly women) who are on antidepressants when they would be better off having their hormones fixed. In the perimenopause, depression is common, and is mainly due to declining hormones. Rather correct them, than take an antidepressant.
The Consumer        August 12, 2013, 2:53 pm

A Glut of Antidepressants

David Plunkert
The Consumer

Advice on money and health.

Over the past two decades, the use of antidepressants has skyrocketed. One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.

Experts have offered numerous reasons. Depression is common, and economic struggles have added to our stress and anxiety. Television ads promote antidepressants, and insurance plans usually cover them, even while limiting talk therapy. But a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale.

The study, published in April in the journal Psychotherapy and Psychosomatics, found that nearly two-thirds of a sample of more than 5,000 patients who had been given a diagnosis of depression within the previous 12 months did not meet the criteria for major depressive episode as described by the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (or D.S.M.).

The study is not the first to find that patients frequently get “false positive” diagnoses for depression. Several earlier review studies have reported that diagnostic accuracy is low in general practice offices, in large part because serious depression is so rare in that setting.

Elderly patients were most likely to be misdiagnosed, the latest study found. Six out of seven patients age 65 and older who had been given a diagnosis of depression did not fit the criteria. More educated patients and those in poor health were less likely to receive an inaccurate diagnosis.

The vast majority of individuals diagnosed with depression, rightly or wrongly, were given medication, said the paper’s lead author, Dr. Ramin Mojtabai, an associate professor at the Johns Hopkins Bloomberg School of Public Health.

Most people stay on the drugs, which can have a variety of side effects, for at least two years. Some take them for a decade or more.

“It’s not only that physicians are prescribing more, the population is demanding more,” Dr. Mojtabai said. “Feelings of sadness, the stresses of daily life and relationship problems can all cause feelings of upset or sadness that may be passing and not last long. But Americans have become more and more willing to use medication to address them.”

By contrast, the Dutch College of General Practitioners last year urged its members to prescribe antidepressants only in severe cases, and instead to offer psychological treatment and other support with daily life. Officials noted that depressive symptoms may be a normal, transient reaction to disappointment or loss.

Ironically, while many patients in the United States are inappropriately diagnosed with depression, many who actually have it suffer without treatment. Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center, noted that from the time they develop major depression, it takes Americans eight years on average to seek care.

Diagnosing depression is an inherently subjective task, said Dr. Jeffrey Lieberman, the president of the American Psychiatric Association.

“It would be great if we could do a blood test or a lab test or do an EKG,” Dr. Lieberman said, noting that similar claims of overtreatment have been made about syndromes like attention deficit hyperactivity disorder. “A diagnosis is made by symptoms and history and observation.”

The new study drew 5,639 individuals who had been diagnosed with depression from among a nationally representative sample of over 75,000 adults who took part in the National Survey of Drug Use and Health in 2009 and 2010. The subjects were then interviewed in person with questions based on the D.S.M.-4 criteria.

Only 38.4 percent of the participants met these criteria for depression during the previous year, Dr. Mojtabai said.

It’s possible some of the participants did not appear to be depressed because they had already been successfully treated, said Dr. Jeffrey Cain, the president of the Academy of Family Physicians. Their improved mood may also have colored the way they responded to questions about the past.

“If I’m checking people who are being treated for high blood pressure and taking medication, I would expect it to be better when I’m checking them,” Dr. Cain said.

According to the D.S.M., a diagnosis of major depressive episode is appropriate if the patient has been in a depressed mood and felt no interest in activities for at least two weeks, and also has at least five symptoms that impair functioning almost every day. These include unintentional weight gain or loss, problems sleeping, agitation or slowed reactions noticed by others, fatigue and low energy, feelings of excessive guilt or worthlessness, difficulty concentrating and recurrent thoughts of death.

“We’re not just talking about somebody who’s having a bad day or got into an argument with their spouse,” Dr. Lieberman said. “We’re talking about something that is severe, meaning it’s disabling and distressing and is not transient.”

Many doctors have long prescribed antidepressants soon after the death of a family member, even though the D.S.M. urges clinicians to differentiate between normal grief and pathological bereavement.

One 50-year-old New York City woman said her doctor prescribed an antidepressant a few weeks after her husband died, even though she thought her feelings of shock and sadness were appropriate.

“He told me, ‘You have to function, you have to keep your job, you have a daughter to raise,’ ” said the woman, who asked that her name be withheld because few friends or family members knew she was taking antidepressants.

Most of the study participants were not receiving specialty mental health care, but Dr. Cain pointed out that it was not clear who was making the misdiagnoses: a psychiatrist, non-psychiatrist physician or other provider, like a nurse practitioner.

But while a psychiatrist may spend up to 90 minutes with a patient before making a diagnosis, patients often are more comfortable with their primary care doctors, who rarely have that kind of time.

Dr. Lieberman suggested watchful waiting may be appropriate in some cases, and more integrated forms of health care may soon make it easier to send patients to a mental health provider “down the hall.”

Doctors need to improve their diagnostic skills, Dr. Mojtabai said, and must resist the temptation “to take out the prescription pad and write down an antidepressant and hand it to the patient.”

Rest up! Too much exercise could send you to an early grave

11 July 2013, 6.39am EST

Rest up! Too much exercise could send you to an early grave

Exercise is said to foster better health and well-being as well as increasing life expectancy. But you can have too much of a good thing, it seems, as evidence shows that there may an optimal level of exercise and exceeding it may be harmful. Even 15 minutes of exercise a day is said to increase life…

Excessive exercise places a significant load on the heart that can result in temporary reductions in function. Ian Hunter

Exercise is said to foster better health and well-being as well as increasing life expectancy. But you can have too much of a good thing, it seems, as evidence shows that there may an optimal level of exercise and exceeding it may be harmful.

Even 15 minutes of exercise a day is said to increase life expectancy by three years. So it seems odd that research published in PLOS ONE last week shows that less active female mice have a longer life expectancy.

In the study, researchers examined a genetic variant in mice (the t haplotype) that they predicted would express a personality trait, characterised by a shy, less explorative and less active nature. Previously, mice with this genetic variant have been shown to live longer.

They found the mice were indeed less active, less exploratory and tended to consume less food.

So should you hang up your training shoes in favour of a less active lifestyle? Well, no. But there is a growing body of evidence suggesting there may be an optimal amount of exercise for improvements in health and life expectancy.

Wearing yourself out

Research shows that people who exercise vigorously can reduce their risk of early death by 40% with up to approximately 50 minutes a day of activity. Beyond this, there appears to be little additional benefit from exercise.

Similar findings reported elsewhere from large-scale studies suggest people who exercise at moderate intensity and duration may experience greater health and survival benefits than keen athletes who exercise daily at high intensities for much longer.

If you are following exercise guidelines (30 minutes a day, five days a week), it’s unlikely that you will see any negative consequences.

But excessive exercise (such as completing a marathon or ultra-endurance event) places a significant load on the heart that can result in temporary reductions in function.

While this decline is often reversed within one week, the long-term effects of repetitive high-intensity exercise may counteract the benefits of moderate physical activity for your heart.

Studies have shown a high incidence of cardiac fibrosis in older, life-long elite athletes, compared to their younger or non-athletic counterparts.

And the prevalence of a common disturbance in heart rhythm (atrial fibrillation), is considerably higher in athletes, particularly in those who have taken part in more than 1,500 lifetime hours of endurance sport practice.

If you follow exercise guidelines (30 minutes a day, five days a week), it’s unlikely that you will see any negative consequences. Image from

A greater danger

Despite these findings, the advantages of participating in physical activity are considerable for the majority of the population who choose not to participate in regular extreme endurance events, or in any exercise at all.

It is well documented that sedentary time, whether it be the number of hours sitting or watching television, is independently associated with poorer life expectancy.

The World Health Organization predicts that physical inactivity is responsible for the same number of global deaths per year (over five million) as smoking.

An intriguing series of recent studies has examined the potential metabolic and cardiovascular benefits of interrupting prolonged sitting time (such as during work hours) with short (approximately two minutes) bursts of mild exercise.

They draw attention to more achievable improvements in physical activity levels in the more sedentary parts of the population.

What about the mice?

But what should we understand from the PLOS ONE study on mice? Well, it aimed to evaluate how animal personality relates to behavioural differences, which is quite a different concept to examining how humans approach health and longevity in the 21st century.

While decreasing activity and saving energy may be beneficial for rodents in the face of potential predators or a reduction in food availability (or both), neither tends to be an issue for the modern human in a developed country.

And while the study suggests there’s greater life expectancy with the genetic variant that made the mice timid and sedentary, it wasn’t actually measured.

Finally, a number of additional behavioural differences (lower food consumption, for instance, and a less explorative nature) potentially contributed to improvements in their life expectancy – less movement and activity may reduce the chances of a rodent being detected by a predator.

Associations are one thing, cause and effect is quite another. Just because two things are observed together, doesn’t mean one causes the other or vice versa. So the lower levels of activity in mice may not be the cause of their increased longevity.

Increasing physical activity for both healthy people and those suffering from a chronic disease is undoubtedly beneficial, providing the approach is sensible and within recommended guidelines.

Although there’s a growing trend for greater participation in endurance events such as the marathon, you should consider how prolonged engagement in such activities may negatively impact your health.

For now, stick with the wise words of Dr James O’Keefe and Dr Carl Lavie:

run for your life….at a comfortable speed and not too far.

Was Blind, but Now She Sees

Was Blind, but Now She Sees

Published: July 17, 2013 71 Comments

BAMAKO, Mali — When you begin to go blind from trachoma, the first thing you feel is an eyelash scraping your eye.

Damon Winter/The New York Times

Nicholas D. Kristof

Enlarge This Image

Ben Solomon for The New York Times

Sadio Diakite received trachoma surgery in rural Mali. The 15-minute eye surgery costs less than $40 per person and can be performed by a public nurse.

Readers’ Comments

Readers shared their thoughts on this article.

As for the horror of leprosy, it often begins with a puzzling rash. Among the first signs of polio are fatigue, vomiting and back pain.

Yet these diseases are on their way out. We in journalism mostly focus on problems, but one of the remarkable changes in the developing world has been the decline of these ancient scourges.

When I first traveled through West Africa, as a student backpacker more than 30 years ago, I was haunted by the beggars disabled by blindness, leprosy and polio. Now I’m on my annual win-a-trip journey with a university student, Erin Luhmann of the University of Wisconsin, and she is encountering a fundamentally improved landscape than the one I saw when I was her age.

Take blindness. It has many causes, but one of the most painful is trachoma, which turns the eyelid inward. The lashes then continuously scrape the cornea.

“My eyes felt as if someone had thrown a handful of sand in them,” Nawara Souko, who suffered from trachoma for years, told us. Her husband is dead, and, without sight, she found it difficult to farm or care for her five children. Three died.

Then Nawara received a 15-minute surgery from a public nurse trained by Helen Keller International, an American aid group. Sometimes the surgery, which straightens the eyelid, comes too late to restore vision. In Nawara’s case, the operation ended the pain — and she could see again.

Erin and I watched trachoma surgeries in a village 100 miles west of the Malian capital of Bamako. Villagers who for years had endured agony — one woman compared it to childbirth, except that it goes on for years — had their lives transformed.

Yagare Traoré said she had spent years in her hut, unable to farm or care for her 11 children, six of whom died. Then she received the surgery, and, after the bandage was removed, a boy stepped forward to guide her home.

“Get out of my way!” she recalled telling him. “I can see! I can walk by myself!”

The cost of this surgery here in Mali is less than $40 per person, according to Shawn Baker of Helen Keller International. So the next time you hear that humanitarian aid is “money down a rat hole,” well, think of Yagare Traoré.

Prevention of trachoma is even cheaper. Train villagers in improving hygiene and distribute antibiotics at a cost of less than $1 per person, and trachoma disappears so that people don’t even need surgery.

Then there’s polio: Only 223 cases were reported last year, down from 350,000 in 1988. Islamist extremists in Nigeria and Pakistan have murdered vaccination workers, but the disease is still inching toward eradication.

A third triumph is leprosy. It can cause hideous disfigurement, including the loss of fingers, toes, ears and the nose, as well as blindness.

Yet a cheap three-drug therapy cures leprosy easily, and a new blood test simplifies diagnosis. The progress is stunning. In 1985, there were 5.2 million people worldwide with leprosy, and now there are fewer than 200,000.

Unfortunately, not everyone gets treated in time. One of our saddest encounters on this win-a-trip journey with Erin was with a 10-year-old boy named Muhammad Bako who had already lost toes and fingers to leprosy.

“I’m fine,” Muhammad told us, but he didn’t look it. He walks awkwardly with crutches, and his eyes burn with fear and the unfairness of it all.

Muhammad is being treated at a 57-year-old leprosy hospital in Niger run by SIM, a Christian missionary organization. The hospital receives about one new leprosy case a month, down from more than 500 a quarter-century ago.

The progress goes far beyond these three ailments. The number of children dying worldwide before the age of 5 has plunged from 12 million in 1990 to 6.9 million in 2011.

As the disease burden declines, the economy surges. Africa is now booming economically, and six of the 10 fastest-growing economies in the world are on the continent. Don’t think of Africa as a place to pity, but as a place to invest.

Journalists and humanitarians understandably focus on unmet needs, and that can leave the impression that the story of global health is a depressing one of failure. In fact, it’s an inspiring story of progress. We need to do more, especially against AIDS, malaria and tuberculosis, but one of the great achievements of humanity in recent decades has been the marginalization of ancient and dreaded diseases.

That’s why it’s possible for me to travel with Erin in some of the most impoverished countries in the world, and feel a glow of hope.

Alternatives for Back Pain Relief

This is my 300th blog. When I started this blog, I was not sure whether it would succeed, or whether I would last the distance. My subscribers have steadily increased, so I  hope I am providing a service that people like. On a theme I generally espouse, that not everything needs treatment, and  letting nature take its course is often the best therapy, I offer the interesting article below.

Alternatives for Back Pain Relief

Ben Wiseman

This column appears in the July 21 issue of The New York Times Magazine.

If you have never suffered from lingering low back pain, you’re lucky or, more likely, young. Up to 80 percent of us will experience low back pain at some point. And for most, there won’t be an identifiable cause.

In the past 10 years, the most popular nonsurgical medical treatment for “chronic, nonspecific” low back pain has been injection therapy, or shots into the lower back of various substances — usually cortisone but also liquid ibuprofen, morphine and vitamin B12. Doctors have been turning to injection therapy at a “disproportionately escalating rate,” according to an overview of back-pain treatments by a team led by Dr. Janna Friedly, a back specialist and an assistant professor of rehabilitation medicine at the University of Washington in Seattle, because it’s relatively easy to administer, less invasive than surgery, can provide some pain relief for a few weeks for some people and is profitable for physicians.

But the benefits do not last, the latest science shows. In a commentary published in May in The Journal of the American Medical Association (JAMA), researchers from the Netherlands point out that there is almost no evidence that the shots ease most people’s pain long term, even after multiple injections. Other recent studies have concluded that injections also do not significantly reduce the likelihood of back surgery later. And in a particularly sobering study published in February, researchers found, to their surprise, that a small group of subjects with pinched nerves in their backs showed less improvement after injection therapy than a control group during a four-year follow-up period. Based on the available data, the JAMA authors conclude, doctors “should not” recommend injection therapy to their patients with chronic low back pain.

The lack of other options that can be administered in a doctor’s office, however, is frustrating to physicians and their patients, says Dr. Friedly. Doctors “want to be able to do something,” she says. But it may be that in their desire to treat back pain, doctors are compounding the problem and creating a disease state where none may exist. “I think we’ve begun pathologizing pain,” she says.

Since most adults develop an aching back at some point, Dr. Friedly says, it shouldn’t always be viewed as an abnormal condition that requires costly medical care. Having some back pain can be a normal aspect of aging that should be met with acknowledgment, patience and, even more important, a change in lifestyle, particularly exercising more.

According to a study published in March, a simple walking program can help adults strengthen their aching backs as much as a more complicated series of back exercises. A comprehensive review published in May in The Clinical Journal of Pain finds that there is “strong evidence for short-term effectiveness” of yoga against back pain, although whether the benefits last beyond a year is less certain. Other experiments have found that Pilates, stretching classes, acupuncture and stationary bicycling each provide some people with some pain relief, although in head-to-head studies, no one of those options is superior to the others.

And perhaps all of them work, to some degree, simply by distracting people. In a 2012 Japanese study, when adults suffering from chronic back pain visited an amusement park, their self-reports of pain dropped significantly, only to climb again as soon as the trip ended.

Herbal Medicines Adulterated, Contaminated or just plain Missing. It’s an International Scandal

13 November 2013, 11.28pm AEST

Herbal Medicines Adulterated, Contaminated or just plain Missing. It’s an International Scandal

Paracelsus’ poison

Consideration of all things toxic and the occasional thoughts of an amateur astronomer

Paracelsus' poison

Ian Musgrave

Senior lecturer in Pharmacology at University of Adelaide

Herbal medicines may contain completely different herbs, be contaminated or have no actual ingredients at all Ian Musgrave

In the wake of the ABC statin story there have been a lot of comments on the Conversation about the evils of Big Pharma. Less attention has been given to Big Supplement, the multimillion dollar herbal supplement industry. Despite the known lack of efficacy of many herbal medicines, and the potential for harm, or contamination, the herbal medicine industry seems to get a free pass.

In the latest revelations, it appears that many herbal medicines have little, if any, of the ingredients on their labels. And what is there instead may be toxic.

The scope of the problem

Regulating herbal medicines can be quite difficult, if you want to ensure a herbal medicine has the mixture of herbs that the label states. In many cases the active ingredients are not known, so you cannot measure the active ingredients to make sure you are getting what you paid for. And most herbal medicines are presented as highly processed powders or teas. One pile of slightly greenish dust looks like another.

Worse still, even if you had access to the original plant, for many plants it takes an expert to tell them from other species that have no medicinal value, or one that may be even toxic.

Currently we largely rely on herbal companies to be honest about what goes into their products. But independent verification of the identity that what people are ingesting for their health is in fact the real deal is highly desirable. So how do you tell if the pile of finely ground plant material is the herb (or herbs) in question. Enter DNA Barcoding.

DNA Barcoding to identfy herbs in Herbal Medicine

DNA Barcoding is an approach to identifying species by looking at particular variable regions in a species DNA. All species are evolutionarily related, so the DNA of species that are very closely related is more similar to each other than species that are more distantly related. So in theory by sequencing the genes of enough species, we can identify which species otherwise unidentifiable tissue belongs to by comparing DNA from the said tissue to a bank of DNA from known species.

The principle is similar to that used in paternity testing and identifying disaster victims.

Simple in theory, complicated in practice, if you choose DNA sequences that don’t vary much, like housekeeping genes, then you can’t tell closely related species apart. If you chose highly variable genes, like the chunks of broken viruses that litter our genome, then more distant relatives will be lost in the noise.

For this research report, Canadian researchers created a DNA sequence bank from known herbs used in herbal medicine. They used sequences from two separate gene regions to improve selectivity and reduce false positives and false negatives. After doing blind testing of known herbal samples to ensure that the tests were selective and sensitive (i.e. when the test said herb x was present it really was present), they then examined 44 herbal products on sale in North America, sourced from Canada and the US.

What’s on the label is not what’s in the bottle

DNA barcode results from blind testing of the 44 herbal products representing 12 companies. Newmaster et al. BMC Medicine 2013 11:222 doi:10.1186/1741-7015-11-222
Click to enlarge

What did they find? Well, the primary finding was that nearly one in ten herbal medicines had no herbs in them, just filler.

I’ll repeat that. Nearly one in ten herbal medicines had no herbs in them. This is an astonishing result. Imagine the outrage if pharmaceutical companies were selling drugs with no active ingredient in them.

The rest of the news was no better, around a third of the herbal medicines had substitutions, where a different species was used instead of the one listed on the bottle. Around a third also had contaminants or fillers that were not listed on the labels.

Overall, less than half of the herbal medicines actually had what was listed on the label.

There are significant health concerns arising from these substitutions. In one case the anti-depressive St. John’s Wort was replaced with the laxative Senna.

Seriously, they replaced an anti-depressive with a laxative. I just spent a good part of Saturday boiling up Senna pods (a story for another day), and I cannot even conceive of how you could get the two confused, even when chopped up. If the substitution was accidental, this is a fundamental failure of quality control and governance. If deliberate, words fail me.

Not only will Senna not relieve depression but Senna can have serious side effects including liver damage if used for some time (as you would with anti-depressants). And this was not the only case where a potentially toxic herb was substituted.

In other cases the contaminants were a serious worry. Many herbs were contaminated with Walnut, possibly leaves that got caught up in harvesting the authentic plant. These have the toxic chemical juglone in them.

Even the relatively harmless fillers can be an issue if they do not appear on the label. Wheat as a filler can be an issue to someone with gluten allergy.

This is not the first study to show contamination and substitution in herbal medicines, but it is the largest and most comprehensive in a developed country.

Australia is not immune

You might wish to take some comfort in the knowledge that Australia’s Therpaeutic Goods Administration treats herbal medicines as medicines. Unlike the United States, where they are treated as food supplements and monitored with less stringent rules than ours. But herbs for the Canadian study sourced in Canada, which has approaches to herbal medicines not dissimilar to ours, were found to have substantial contamination and substitution issues.

And the TGA’s rules will not necessarily help. The TGA relies on honesty from sponsors of herbal medicines when they are registered, with post marketing follow-up. This follow-up consists of random surveys and targeted surveys from concerns raised by consumers.

Given that there are over 10,000 licensed herbal medicines in Australia, and nearly 2000 new herbal medicines being registered each year, the number that can be checked by this method is rather small. In a TGA survey in 2009-2010, 110 complementary medicines were tested. An astonishing 90% of complimentary medicines surveyed were non-compliant with their licence conditions.

The license conditions cover everything from advertising and unsupported therapeutic claims to composition. Forty one (37%) of these non-compliance’s resulted in the sponsor withdrawing the medicine or the TGA revoking the licence. In the same time frame no prescription or over the counter medicine had their licences revoked.

We don’t exactly know what proportion of these revoked licences are due to herbal medicines having the wrong ingredients or being contaminated, but recent cancellation notices suggest that 11% of all cancellations are due to problems with component concentrations or contents. This sampling result indicates that Australia, like the rest of the developed world, has a significant problem.

The Herbal Medicine Industry is an international industry, with products travelling all over the world. The widespread substitution and contamination of herbal medicines is an international scandal. Despite the vigilance of the TGA, Australia is almost certainly not immune from this scandal.

Disclaimer: I’m one of a group of researchers who have just won an NHMRC grant to determine the extent of contamination and substitution of herbal medicines in Australia.