On November 14, 2017, Business Insider reported that kratom, an herb indigenous to Southeast Asia, had been linked to 36 deaths. Due to its classification as an unapproved drug, FDA Commissioner Scott Gottlieb released a statement strongly discouraging the public from using the drug for any purpose. According to the FDA’s statement, kratom has been marketed as a treatment for depression, pain, and anxiety. Its proponents tout its ability to heal a broad range of illnesses, implying that kratom is safe because it is natural. However, the FDA warns that kratom shares similar properties with opioids and can be just as addictive and, in some cases, deadly.

But, what can kratom, a southeastern Asian herb linked to 36 deaths, teach us about herbal supplements? It teaches us that natural herbs are no safer than medications created in a laboratory. Just as in their synthetic counterparts, they can interact with other medications and herbal supplements, causing someone to become very ill or die. In this piece, we’ll take a look at some common herbal supplements, herbal blends, their marketing, and how they may generally interact with certain conditions and medications.

What are herbal supplements?

According to the FDA, herbal supplements are classified under the category of dietary supplements. This means that the FDA does not apply the same rigors of testing and regulation to herbal supplements as they do for pharmaceutical drugs or food. In essence, while product manufacturers must adhere to certain guidelines ensuring their products are uniformly produced and of a high quality, manufacturers do not require FDA approval before they market them or stock them on health food store shelves.

What are some common herbal supplements, their uses, and potential interactions?

Echinacea
Echinacea — also known as purple coneflower and Black Sampson — is an herbal supplement commonly marketed as a treatment for colds, ear infections, migraines, and attention deficit hyperactivity disorder (ADHD). According to herbalists, echinacea is also beneficial in treating gingivitis, tonsillitis, and many more.

Although some people take echinacea alone, some manufacturers market their echinacea as a blend. In this example, both echinacea roots and seeds are listed as the top two ingredients. According to the FDA’s food labeling guidelines, this means that “Echinacea Angustifolia Root” and “Echinacea Purpurea Seed” are the two most abundant ingredients in the blend.

However, before you go to look up possible drug interactions with echinacea, be sure to read the entire list of ingredients thoroughly. For instance, further down the list, you’ll find fresh garlic bulb along with fresh habanero pepper and juice. In that case, research potential drug interactions for both garlic and habanero pepper.

Be sure to inform your healthcare practitioner that you’re taking echinacea, and avoid it if you have autoimmune diseases such as rheumatoid arthritis, lupus, etc. Also, let your healthcare provider know if you have allergies to plants, especially to flowers like mums or daisies. Next, do not give echinacea to a child younger than 12 years of age without a healthcare provider’s instruction, supervision, or counsel.

Last, but definitely not least, do not mix different echinacea teas, tinctures, tablets, and blends together. This may lead to an overdose.

Ginseng
Also known as Canadian and Americano ginseng, this is an herbal supplement commonly marketed as a treatment to lower blood sugar levels in patients with type 2 diabetes after meals. It is also said to treat respiratory infections, enhance athletic performance, alleviate symptoms of menopause, and treat memory loss. However, as in other herbal supplements, the FDA has not approved this herb for treating those conditions. Additionally, there are no uniform manufacturing standards in place.

As in the previous herb, ginseng is often taken by itself, but it may also be sold in blends. In these cases, different ginseng roots are combined along with other herbs. Again, be sure to read through the entire ingredient list, researching potential interactions for every ingredient.

As always, discuss your use of ginseng with a qualified healthcare practitioner. Make sure to tell your doctor if you have conditions such as diabetes, or cancer — especially breast, uterine, or ovarian cancers. At the advice of your healthcare provider, you may also want to avoid taking ginseng if you have a mental condition, such as schizophrenia or depression.

In short, though herbal supplements can be a great supplement to standard allopathic treatment, always, always talk to your doctor first. Be honest about all your medical conditions, other medications you may be taking and other herbal supplements you’re using. Tell your doctor everything you’re taking, even if it’s natural. Due to the lack of strict regulation and testing, natural herbal supplements are not always safe — especially in conjunction with other herbs or pharmaceutical medications.