Q1: Why should I use herbal products?

There are many good reasons to consider herbal products to complement and supplement your health. One of the best reasons, may be the fact that herbs and herbal products, have been used so widely throughout time and history and their remarkable safety profile.

In fact, the World Health Organization has estimated that 80% of the world's population continues to use traditional therapies, a major part of which are derived from plants, as their primary health care tools.(1)

Herbal supplements include single herb or a combination of herbs. They may be used for treatment or as preventives. These products are found in the form of teas, tablets, capsules, liquid extracts, tinctures, and others.

Q2: Are herbal supplements safe?

As we may be already aware that in our day to day living, we often flavor our food with a number of herbs to make a meal more tasteful. For example, we can appreciate a delicious cup of peppermint or ginger root tea, or benefit from the soothing properties of marshmallow root or the bark of slippery elm. Although allergic reactions have been recorded for a number of herbs that are widely used in foods and supplements, the general safety profile of many herbs are well recognized. On the other hand, and as everyone knows, there are some plants that are highly toxic, even deadly. The death sentence imposed on Socrates by an Athenian jury 2,400 years ago was carried out with a fatal dose of hemlock (Conium maculatum).

The poison curare, a blend of several equatorial rain forest plants (e.g., species of Chondrodendron, Curarea and Strychnos)(2) is used by some South American hunter cultures to make their arrows more deadly.

Norman Farnsworth, Director of the World Health Organization Collaborating Centre for Traditional Medicine and Research Professor of Pharmacognosy at the University of Chicago at Illinois, is generally considered to be one of the most respected experts on the scientific research of botanical medicines and in his written article on the subject of herbal safety,(3) Dr. Farnsworth concluded, ...side effects or toxic reactions associated with herbal medicines in any form are rare. In fact, of all classes of substances reported to cause toxicities of sufficient magnitude to be reported in the United States, plants are the least problematic.

However, this should not be construed by saying that every herbal ingredient that is sold in a supplement is appropriate for every consumer or in any quantity. Responsible and informed use by consumers is essential to insure that herbal products maintain their established safety profile. Accurate product labeling must provide consumers with all information that is related to the use of the product.

Q3: Are herbal supplements effective?

Botanical remedies have been an important source of traditional medicine for thousand of years. They have made tremendous contributions over the last centuries to the development of some of the most widely used and effective modern drugs. In the last several decades, there has been a resurgence of research in the clinical efficacy of herbs. For example, Ginkgo biloba extract contains 2 main groups of active compounds called ginkgoflavonglycosides and terpene lactones. Standardised Ginkgo biloba extract contains 24% ginkgoflavonglycosides, 6% terpene lactones and less than 5 ppm of ginkgolic acid, a toxic compound which may cause allergy.

Ginkgo biloba extract has been scientifically proven to have powerful effect on macro and micro blood circulation.

Often referred to as a living fossil, Ginkgo biloba is believed to be the longest living tree on earth, a specie that thrived 65 million years ago and continued till today. Its medicinal use can be traced back to the oldest Chinese Materia Medica about 2800 B.C. and is probably one of the world’s most widely used therapeutic herbs.

The manufacturer therefore has due responsibilities to ensure that the indications stated for their products are supported by scientific evidence. There are many clinical studies reported world wide on certain popular herbs and its effectiveness in helping various disorders.

Most of the latest research reviews are published in international medical journals like Journal of American Medical Association, British Medical Journal, Planta Medica and The Lancet. In Germany, The German Commission E publishes monographs on the safe use of all clinically proven herbs on a yearly basis. More recently, a number of U.S. companies have designed clinical studies for their branded products. There are estimated over 1,000 clinical trials now being undertaken in the U.S. to further increase our overall knowledge about herbs.

Q4: If herbs are so effective, why don’t doctors regularly recommend them?

Western doctors are trained to diagnose pathological aspects of diseases and to prescribe medication for the relief of symptoms and therefore have little training in herbal medicine. However, in some countries like France & Germany, China herbal medicine has been successfully integrated into their medical system and doctors are trained to include herbal medicine where appropriate. With ongoing clinical trials & research on herbal medicine we may foresee a change in trend in the future and have more doctors recommending herbal medicines as part of their routine treatment.

Q5: What does standardized herbs extract mean?

Standardization refers to the level of active ingredients (single or a group of compounds) is guaranteed at a certain percentage of the total weight of the extract. A reputable manufacturer of herbal extracts will need to certify, through laboratory testing using precise High Performance Liquid Chromatography (HPLC), UV / Vis Spectrophotometer instrument, that these products contain the stated amount of specified constitutes and ensure product consistency in every production batch.

Standardisation provides more consistency in the level of the active constituents to minimize the natural variation in raw materials.

Q6: Some brand labels seem to indicate strength in thousands of milligrams (mg), is this an indication of efficacy?

Not necessarily. Some brands contain crude herbs which have not undergone any extraction process to gain concentrated levels of active ingredients, thus they come in thousands of mg. Standardisation however compensates for the natural variability you find in bulk herbs and it ensures the exact amount of active ingredients. For example, a 40mg Ginkgo biloba standardised extract tablet is equivalent to 2000mg of Ginkgo crude herb.

Q7: Can herbal supplements be taken in conjunction with prescription drugs OR what about interactions with drugs?

For example less than 10 years ago it was found that drinking grapefruit juice increases the serum drug concentration when patients take certain drugs.(23) This effect, which can last for up to 24 hours after consumption, is now thought to be due to the inhibition of specific enzymatic activities responsible for breaking down the drugs.(24) Similarly, both avocado and leafy vegetables that are high in vitamin K can diminish the effectiveness of blood-thinning drugs.(25)

These concerns are not widely known by the public, but now that medical professionals are aware of these effects, they can routinely monitor their patients to assure effective treatment. Similar information has surfaced about some of the herbs that we use. For example, we now know that the use of an extract of St. John's wort (Hypericum perforatum) may cause certain prescription medications to be eliminated more quickly,(26, 27) leading one researcher to caution that, As with grapefruit juice, a food product, physicians should also be aware of potential drug-herb interactions.(26)

In response to this new information, the American Herbal Products Association has recommended that products containing St. John's wort be labeled to suggest that the advice of your prescribing physician be requested if you are taking any prescription drugs. Speculation on the exact mechanism of St. John's wort has led to reports that the use of this herb might affect oral contraceptives, leading to ineffectiveness and unwanted pregnancies. To date, there have been no reports of any such actual occurrence.

Nevertheless, women taking oral contraceptives such as ethinyl estradiol and desogestrel should be aware that, if you experience break-through bleeding, you might experience a reduction in protection against pregnancy. As can be seen by the above examples, the effect of a drug can be either increased or decreased in the presence of other factors in the diet, including herbal use. Although it is likely that most such factors have little or no influence on drug metabolism, continued research will add to our knowledge of such interactions and responsible food and supplement manufacturers will be expected to inform their customers of any new findings.

There is now an ongoing interest in other drugs that are suspected of interacting with certain specific herbs, with most contemporary emphasis on the use of herbs with blood-thinning drugs such as warfarin. Although the current concerns are either conceptual or based on isolated and inconclusive reports, it is advisable to inform your prescribing physician or pharmacist that you are using herbs when undergoing any drug therapy. As close monitoring of the effect of warfarin is an established standard of medical practice, this additional information will assist your physician in maintaining good supervision of your drug levels. In order to understand the potential for an herbal product to interact with prescription drugs, it may also be useful to consult with a qualified herbal expert.

Most herbs can be taken together with prescribed medications because they are known for their supportive role to body systems.

A classic example is the use of Echinacea during and after antibiotic treatment since it can promote the function of the immune system. Herbs can also reduce the side effects of some drugs. Clinical studies on Milk thistle have shown that it can help keep the liver functioning normally in individuals taking antidepressant drugs. However, there is now an ongoing interest in other drugs that are suspected of interacting with certain specific herbs, with most contemporary emphasis on the use of herbs with blood-thinning drugs such as warfarin.

Generally, herbs with therapeutic effects similar to a specific drug should not be consumed together. As an example, it is not advisable to take St John’s Wort ( Hypericum perforatum, clinically proven for depression) with an antidepressant prescription or Saw Palmetto ( Serenoa serrulata & repens, clinically proven for prostate enlargement) with a benign prostate enlargement drug.

Q8:How can I choose the herbal supplement that is RIGHT for me?

First ensure the correct diagnosis of the condition and the appropriate herbs and dose enquired. Where possible select a standardized extract that contains the necessary level of active ingredients for its efficacy. Look out for its unique and special processing methods used to enhance the absorption level. You may like to ensure the medicinal value of the herb is clinically proven. The superiority of a brand depends on the manufacturer’s commitment in upholding stringent quality control by performing detailed product testing which must include heavy metal detection disintegration test microbiological as well as active ingredient assays.

They must also bear a valid registration number from the Ministry of Health and a hologram as authenticity. Finally, if the product you have been taking works for you and provides the promised benefits, stick and stay with it.And also remember a brand that is significantly less expensive than other products with the same or similar ingredients is not necessarily always the best bargain.

Q9: Is it safe for children and pregnant women to take herbal supplements?

The usage of medical plants in pregnant women and children will depend on the dose, the type of herb used and the specific condition it is used for. Administrating adult doses for children should only be done in consultation with a qualified herbalist. Under normal circumstances always begin with a low dose and slowly work your way up over a period of 3 days. Pregnant women should remain cautious whenever taking any form of medication including herbs unless advised by their doctor.

Q10: What is GMP?

GMP is Good Manufacturing Practice, which is a set of standard guidelines, provided by the Malaysian Ministry of Health, to control and regulate the manufacturing of pharmaceuticals and health supplements. These standards enforce a controlled and systematic manufacturing process to safeguard the quality and safety of products. The quality of a company’s products can be further endorsed by complying with ISO Quality Management System and having their own in-house quality control laboratory.

Q11: Are imported brands superior to local Malaysian brands?

Local manufacturers are subject to Good Manufacturing Practice licence and must be approved by the Ministry of Health, Malaysia to ensure the safety of their products is consistently maintained. However, even in advanced countries like USA and Japan, the manufacturing of herbal supplements are not required to comply with GMP which can impact their quality and may result in inferior products. Thus not all imported brands are superior over local ones.

Q12: How soon can I expect to notice the benefits of a herbal product/supplement?

Herbs are rich mixtures of diverse natural compounds. Some of the herbs give apparent effects within a short time after consumption. For instance, ginger root (Zingiber officinale) or peppermint leaf (Mentha x piperita) tea is used traditionally to promote healthy digestion with comforting and soothing effects as you drink these herbs. The effect of ephedra (Ephedra spp.) in promoting bronchodilation or better breathing is usually felt within ten or twenty minutes of use. Similarly, all of the herbs that contain anthrones — such as rhubarb root (Rheum spp.) or cascara sagrada bark (Frangula purshiana) — will produce a laxative effect within a half a day or so.

Other herbs are known to produce noticeable benefits only after several days or weeks. For example, improvement in sleep when using an extract of valerian root (Valeriana officinalis) has been shown to be somewhat dependent on continued use.(4) With saw palmetto (Serenoa repens), which is used to promote the health of the prostate glands, the full benefits are seen after 12 to 18 months.(5). Yet other herbs, such as those that are rich in antioxidants, improve your health without a noticeable effect. In conclusion, the exact duration of herbal remedies would depend on a number of factors. In many cases it is determined by published findings from past clinical studies.

However, there are variations in the results obtained because, like most drugs, herbs affect people in different ways.It is therefore logical to say that the duration necessary to provide adequate desired effects would depend on the following factors :-

 1. the correct therapeutic dosage needed
 2. the severity of a given condition
 3. the overall health of an individual
 4. the quality of the herbal supplement
 5. the discipline in strictly adhering to the recommended dosage.

It is important to bear in mind that herbal alternatives often do not provide immediate results, instead they work gradually in improving a specific condition over a period of time.

It is worthwhile the wait and exercise some degree of patience in view of its long term benefits, with significantly less or no side effects.

Q13: Should I tell my Doctor that I'm using herbs/herbal supplements?

You should! And since your doctor is, ideally, your primary healthcare partner, you should insist that your doctor, no matter their degree of training in herbs, receive that information respectfully. Moreover, your doctor and being your personal physician has a responsibility to guard and oversee the safe and effective treatment of any medication as there are some herbs which have potential interactions with prescription drugs.

Alternatively, you may wish to consult a qualified herbal expert for his professional advice.


  1. Akerele, O. 1992. WHO Guidelines for the Assessment of Herbal Medicines. Fitoterapia 63(2):99-104
  2. Schultes, RE and RF Raffauf. 1990. The Healing Forest.
  3. Farnsworth, NR. 1993. Relative Safety of Herbal Medicines. Herbalgram 29.
  4. Leathwood, PD, et al. 1982. Aqueous extract of valerian root(Valeriana officinalis L) improves sleep quality in man. Pharmacol Biochem Behav 17(1): 65-71
  5. Bach, D. and L. Ebeling. 1996. Long-term drug treatment of benign prostatic hyperplasia-results of a prospective 3-year multicenter study using Sabal extract IDS 89.Phytomedicine 3(2):105-111