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

Manufacturers call them dietary supplements, or natural substances that stimulate normal body functions, but herbals still are drugs, according to authorities on herbs.

"Just because it's (available) over the counter doesn't mean that it isn't potent and doesn't have the potential for problems," Joel Luitjens, pharmacist at Lewis Family Drugs in Windom said. "They have some good things, they have some bad things. So a wise consumer is the best consumer. It's just that people need to get that knowledge on how they should take it and what to be looking for with problems."

The floodgate for herbals opened in the early 1990s when these substances were reclassified by the Federal Drug Administration from drugs, to nutritional products. However, without FDA control, systematic monitoring for possible side affects lags behind availability, as does general knowledge about interactions with prescription and other medicines, standardization of active ingredients and surveillance of overall quality.

Consumer interest in herbals and pharmacists' concerns for patient safety prompted the Minnesota Pharmaceutical Association to form a committee dealing with these substances, said Rita Tonkinson, vice president of communications for staff liaison and the special committee. Members now have a data base of herbal information and are involved in a post-market medical surveillance program.

"A lot of people have a misconception that if it says natural, there's no harm done to them by ingesting these, and that's not necessarily true," Tonkinson said. "One of the concerns of the committee is that there really is no federal, or state agency that truly monitors and collects data on herbals. A lot of pharmacists are really concerned about safety standards, because there are none. There's no quality standards, and no standards in the active ingredients."

Association member Rick Kingston supports the responsible use of herbals, coupled with post-sale surveillance. Kingston is 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 the University of Minnesota. He also is a senior toxicologist at the Prosar International Poison Center.

"I believe these substances have tremendous value in a variety of different ways, from nutritional support, to the treatment of actual medical conditions," Kingston said. "The difference is knowing when to use them, when not to use them, when you might run into potential complications when using them, and lastly, whether you are really getting what you're buying."

Some regulations do exist, but no one enforces them, Kingston said.

"The FDA is not just taking large amounts of these products off the shelf and testing them for purity," Kingston said. "They wait until someone reports a problem. Even though (herbals) have enjoyed a wide margin of safety for the most part, you never can tell when you might have a circumstance where a product ends up being contaminated, or you have a manufacturer that's not up to snuff, or interactions."

Even with prescription drugs, dangerous side affects sometimes surface only after long-term monitoring of general use, Kingston said.

"When we've got all these substances out there that nobody's really systematically looking at, you've got to believe that something might be happening out there that we're not privy to because we're not looking for it," Kingston said.

Additionally, many herbal agents can impact an individual's regular medication, and vice versa. For instance, St. John's wort by itself is safe, Kingston said. But it can affect the metabolism of a variety of other substances. Doses sometimes can be altered, but doctors need to know every substance a patient is taking in order to avoid interactions.

Like prescription medicine, some herbals work better for some people than others, but unlike controlled substances, different herbal batches can pack different punches, depending upon manufacturing practices, Luitjens said. Some herbs lose potency at certain times of year, and in general, the amount of active ingredients varies between plants.

If a company packages herbs by weight, rather than by active ingredients, potency can range from high, to nil, Luitjens said. Companies that measure active ingredients to ensure uniformity generally label their products "standardized."

"It might cost you more, but you know what you're getting," Luitjens said.

Luitjens recommends taking herbals individually, rather than as compounds, in order to better monitor reactions.

"If you buy a complex, which has several different things in them, you can't necessarily narrow down what is causing the side affect, or problem," Luitjens said. "I always like to keep it simple and very direct."

Luitjens talked on some of the more popular herbals at the recent 21st Annual Regional Conference on Aging at the Windom Community Center, and he gave the following information and advice:

* St. John's wort combats mild, to moderate depression and should be avoided when taking other antidepressants. It works with the body to build up seratonin, which regulates mood, and can cause slight drowsiness and sun sensitivity. It takes up to three weeks of regular use to feel the affects.

* Kava-kava eases anxiety and calms nerves. It causes drowsiness; other anxiety medications and alcohol should be avoided. Some literature suggests it is habit-forming and should be taken for a few weeks, to a month at most.

* Gingko baloba benefits the cardiovascular system and brain by improving blood circulation. Like many herbals and other over-the counter medications, it should not be taken with blood thinners.

* Valerian root and melatonin induce sleep. Valerian root capsules give off a strong odor, but ingesting them does not cause bad breath.

* Glucosamine is used by the body in the production and maintenance of cartilage and is taken for mild to moderate arthritis. It often is combined with condroiton. It is safe taken with pain relievers. Improvement can take a month or more.

* Cats claw relieves pain and reduces inflammation. Its potency varies drastically based on when it's harvested. It can lower blood pressure and should not be taken with blood pressure pills, or with another anti inflammatory or pain reliever.

* Ginseng is an energizer. Korean and Chinese ginseng contain more caffeine than the American version. It affects sugar levels and is not recommended for diabetics.

* Echinacea stimulates the immune system and often is bottled with goldenseal, for inflammation and infections. A regimen should not exceed eight consecutive weeks, with at least a month break.

* Saw palmetto, with prolonged use, shrinks enlarged prostates

* Ginger aids digestion and helps alleviate nausea.

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