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(This is part one of a two-part series. Concerns over herbals are addressed in part two.)

When sleep is elusive, joints ache, or depression sets in, southwest Minnesotans increasingly reach for herbal supplements.

Vitamin sections of drug, grocery and discount stores in the region are filled with bottles bearing names like ginkgo biloba, glucosamine condroitin and echinacea, and demand for these supplements is growing as more information about their affects becomes available, although additional, reliable information still is needed, area pharmacists who were interviewed said.

"The baby boomers kind of like the natural products -- they're health conscious," said Joel Luitjens, chief pharmacist at Lewis Family Drug in Windom who talked on herbs recently at the 21st Annual Regional Conference on Aging at the Windom Community Center. "The older people, they're looking for cost savings. Same with the younger people. They're looking for cost savings, and they just don't like to go to the doctor."

Herbs, once prescription drugs, were reclassified by the Federal Drug Administration in the early 1990s as nutritional products. Consequently, they no longer are subject to FDA regulation, Luitjens said. This is leading to their comeback, but without FDA control, manufacturers are prohibited from making medical claims, which limits readily available information about their affects.

"If you read herbal bottles, they will say, 'promotes good health.' That's kind of vague," Luitjens said. "Or, if they do make a little bit more specific claim, they will say it hasn't been approved by the FDA. So to get good information on herbs is sometimes hard."

Most people in the area acquire their herbal knowledge by talking to other people, Luitjens said. Others turn to the Internet.

"The Internet can have some good information, the Internet can have some very poor information," Luitjens said. "If it's coming from a university, that's a good site. If it's a manufacturer's site, I would take it with a grain of salt. They're hyping the products they're trying to sell."

Still others seek information from pharmacists and doctors, but not all pharmacists are knowledgeable about herbs, and even fewer doctors possess this knowledge, Luitjens said.

"Some pharmacists are very skeptical of it, so they shy away from it," Luitjens said. "And no one is talking to doctors about herbals here. There aren't any manufacturers coming in, or salesmen coming in to talk about herbals, so, that makes a difference. Doctors know drugs, but they don't know the ins and outs. Herbals, they know zero -- there's no training in [medical] school."

The University of Minnesota is trying to introduce more information into its curriculum on alternative medicine practices, said Rick Kingston, an assistant professor in the department of experimental and clinical pharmacology and course director for the therapeutics of herbal and other natural medicinals in the college of pharmacy at UMN. Kingston also is a senior toxicologist at the Prosar International Poison Center.

"We're putting out practitioners that are going to be graduating soon, and they're going to be much better educated and able to help patients along these lines," Kingston said.

The university also is creating an online herbal course for practicing pharmacists and is considering an outreach online education program for consumers. Elsewhere, the Mayo Clinic is organizing a new alternative medical program to look at these substances, Kingston said.

As interest in herbals grows, people are demanding more wellness and nutritional information from their health care practitioners, who typically steer away from spending time in their practices learning about things insurance companies won't cover, Kingston said.

"We're seeing a tremendous change in consumer control over their health care, which I think is very good. Patients are in a much better position now, with having access to more information and exercising their right to be essentially the final decision-maker in their health care," Kingston said. "It's one of those situations where you want to go to a knowledgeable individual that's going to help you, but you also want to be very much a part of the decision-making process with what needs to be done, and more people are just being vocal about that."

Lots of customers expressed a desire to try herbal remedies before taking prescription drugs when Pharmacist LeAnn Gruhlke worked at a pharmacy in Windom. However, she said that now as a pharmacist at Throndset Pharmacy in Jackson, she sees relatively low demand.

"I think a lot of people are curious about it," Gruhlke said.

Customers at Bryan's Pharmacy in Fairmont buy a great deal of herbals, said Deb Roggow, staff pharmacist.

"And it just seems to get more and more," Roggow said. "You'd be amazed. People hear that it's an herb, and they're willing to try anything. If it's a drug, they're not as willing."

Older customers generally seek treatments for arthritis and sleeplessness, she said.

"With baby boomers, then it's everything from weight loss, to depression, to you name it," Roggow said.

Although demand waned somewhat during the last year at the Medicine Shoppe Pharmacy in Willmar, Pharmacist Steve Cederstrom said he is counting on renewed interest and is expanding his shelf footage for herbals. Some of the more popular remedies target aching joints, blood pressure, and overall energy.

"We're finding that the consumer was kind of disillusioned because they didn't have a lot of places to go to get their answers," Cederstrom said. "Independents like myself, we are starting to see growth in it again because we have become more of an information source."

With a new computer system and special software, the pharmacy is in a position to act as a reference for both consumers and health care practitioners on all types of substances, including the vitamins they deplete and known interactions, Cederstrom said.

Milt Lueneburg, a retired, relief pharmacist at Family Pharmacy in Hutchinson said the pharmacy stocks only a few herbals, and that he isn't as versed in their affects as he was once.

"We obviously have a few that the people ask for, like ginseng and St. John's wort, but we're not into it like you see in a lot of places," Lueneburg said. "Fifty some years ago, when I was going to pharmacy school, that's what medicine was made of mostly, was herbs. There were all kinds of directions for making the herbs, the concentrations you had to have. We've gone full cycle on this, but over the years you just forget what the heck they're all about."

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