Coming Into Their Own

Bottles and boxes fill an entire aisle, offering all-natural relief from a cornucopia of ailments: memory loss, insomnia, hay fever, enlarged prostate, menstrual cramps, depression, back pain, headaches.

The products--ginkgo biloba, valerian, red clover, saw palmetto, feverfew, St. John’s wort, milk thistle, cat’s claw, echinacea--used to be found only in a botanist’s guide or a health-food store.

But this is an aisle at Sav-On, where shoppers place the herbal products in their carts next to plastic plates and discount knickknacks.

Herbs and other natural remedies have gone mainstream. No longer the sole domain of health food purists, they now are being gulped down by the Wal-Mart set.

A survey conducted earlier this year by Prevention magazine found that one in three--60 million people--spends an average of $54 per year on herbal remedies, about $3.24 billion. The herbs are sold in supermarkets, discount stores, by mail order, over the Internet and by “multilevel marketers” such as Amway.

Another national survey conducted about two years ago found that 45% of Americans were aware or had tried herbal products, but that only 16% used them regularly. The same poll, conducted earlier this year, found that 70% are aware or have tried herbs, and that 40% are using them regularly.

Whole Foods magazine--affiliated with Whole Foods markets--reported in its October issue that sales of its brand of herbal supplements in 1996 increased 59% over 1995 figures.

And use of herbs is gaining acceptability--although at a slower pace--in the conventional medical community, too, as evidenced by several scientific studies on herbal usage, published recently in staid medical journals.

“It’s no longer a fringe movement,” said Mark Blumenthal, executive director of the American Botanical Council, a nonprofit organization in Austin, Texas. “This is not just folklore and hippy dippy and voodoo. People are finding out there is research to support it. There is a scientific side to it.”

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The herbal market boom has been building for several years, although measuring it is inexact because there is no overriding regulatory agency. Consequently, information mostly comes from the various purveyors, who often measure their own sales in different ways, making it tricky to compare or compile statistics.

The reasons for the mainstreaming of herbs are many, authorities said. A big boost came in 1994, when a federal law was passed removing much of the U.S. Food and Drug Administration’s regulatory powers over dietary supplements, clearing the way for broader marketing.

But there was a market ready to receive them. The baby boomers who grew up with the environmental, natural foods and return-to-the-soil movement were hitting middle age and eager to seek alternative remedies to menopausal discomfort, prostate enlargement and other age-associated aches and pains.

Those baby boomers also tend to have money to spend, are expected to live longer than their parents and want to stay healthy during those years, said John Troup, a vice president with General Nutrition Cos., which operates 3,000 General Nutrition Center stores.

“They’ve seen their parents age, and they don’t want to suffer themselves,” he said. “People are trying to extend the life of their years, not just extend the years of their lives.”

Also feeding the boom is the high cost of medical care, he said. Every $5 spent on preventive care saves $30 in medical care, Troup said.

And there is growing consumer dissatisfaction and mistrust of new drug treatment prescribed by physicians, said American Botanical Council’s Blumenthal.

“Every few months, we see how some drug that went through extensive reviews by the FDA is linked to adverse effects that were not anticipated,” he said, citing the recent FDA decision to ban two popular diet drugs.

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Still, herbal remedies do not provide all the answers, despite promises on some of the packaging, authorities warn. Concerned by largely unregulated claims by some herbal product manufacturers, a presidential commission last month strongly recommended that the FDA establish a panel to review botanicals. It also urged health professionals to learn more about supplements to better assist patients in choosing them.

There is slow but increasing acceptance by physicians, Blumenthal said. Still, he said, physicians are learning about herbs--and in some cases, even selling them--mostly because they know their patients are interested in them.

Nonetheless, the medical establishment has lent credence to the use of herbal products by publishing findings in scientific journals.

Last year, the British Medical Journal reviewed 23 studies--most originally published in non-English journals--on use of St. John’s wort for treatment of depression. It concluded that the folk remedy worked better than a placebo and as well as many antidepressant drugs. In October, the Journal of the American Medical Assn. published a report that linked usage of an extract of the ginkgo biloba tree to modest improvement in mental functioning among Alzheimer’s patients.

Dr. Richard M. Glass, JAMA’s deputy editor, said the journal’s editorial board has identified alternative medicine as an area of interest for the publication, and a themed issue next year will be devoted to the subject.

Nonetheless, Glass said, the scientific criteria for studies involving natural remedies remain the same as for studies of conventional drug therapies. One of the concerns about herbal use, he said, is that quality and purity can vary among preparations. Any studies must address those concerns, he said.

Blumenthal said that while he is thrilled to see American conventional medicine’s interest in researching herbs, there already is “a considerable body of research” documenting the effects of the supplements, although most of it has been conducted overseas, mainly in Germany.

News of these benefits--spread by television newsmagazines, general and special-interest magazines, other media and by word-of-mouth--has fallen on consumers’ receptive ears in this country, he said.

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What are the most popular herbs? Whole Foods magazine’s recent survey among participating retailers gave this order:

1. Echinacea, also known as the purple coneflower, is said to offer relief from cold and flu symptoms. This is the third year it was ranked first.

2. Garlic, which boasts a host of benefits, including reducing blood pressure and cholesterol and helping to prevent colds and other infectious diseases.

3. Ginkgo biloba, which reportedly improves circulation to the brain and lessens ringing in the ears.

4. Goldenseal, a popular remedy for cold and flu symptoms.

5. Saw palmetto, said to promote prostate gland health.

The remainder were: aloe, which acts as a laxative taken internally and a skin treatment externally; ginseng, said to increase resistance to stress; cat’s claw, which reportedly boosts the immune system; astragalus, said to have immune-enhancing properties; and cayenne, said to help relieve pain.

The survey also found that St. John’s wort is expected by retailers to be the hot-selling herb this coming year, thanks in part to coverage by the media touting it as “nature’s Prozac.” Saw palmetto, kava (a relaxant), echinacea and ginkgo biloba rounded out the list.

But physicians, while gaining acceptance of herbal remedies, also caution patients about using them.

“There is a kind of myth that natural means safe and good, but there are plenty of natural things that are harmful,” such as wild, toxic mushrooms, said JAMA’s Glass.

Further, he said, using an alternative treatment may prevent or stall an ill person who needs effective medical care, he said. Or it might interact with prescription drugs.

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Dr. Joseph Scherger, a family practitioner and associate dean of clinical affairs at UC Irvine’s College of Medicine, said that while he considers himself open to holistic-style therapies, he finds most of the claims by sellers of herbal remedies to be “overstated and market-driven.”

The reported benefit of many herbs “is more based on belief” than science, Scherger said. “It’s more like a religion.”

More reliable as a natural preventive measure, he said, is eating a low-fat, high-fiber diet and exercising regularly.

Scherger said that UC Irvine trains doctors to ask patients about their use of natural remedies and, unless the preparations pose harm, to be nonjudgmental. It is important to establish good communication and trust with patients, he said, adding “we don’t want to take away people’s beliefs.”

Most herbs are, indeed, harmless, but some herbs do have the potential for harm, he said. Use of herbal remedies might mask symptoms of an ailment that a physician should treat. Some herbs have effects the patient might not foresee. The popular St. John’s wort, Scherger said, can bring on high blood pressure, even stroke, in some people if red wine or certain aged cheeses are consumed.

“I see this as more of a cultural phenomenon than as a breakthrough in medicine,” he said of herbs’ growing popularity. “It’s a cyclical thing. Ultimately, the only things that last are borne out with scientific truth.”

But GNC’s Troup said that herbal usage tends not to be faddish because consumers in general are cautious and want information before downing a natural remedy.

In addition, he said, people expect immediate improvement with faddish products, while consumers of herbal preparations know “these work over a long period of time.”

He is not impatient with the medical community’s slow acceptance. “They have legitimate concerns” about quantifiable results, standardized preparations, and other variables that now exist, he said.

“But as these issues are addressed for the practitioner,” Troup said, “support will continue to grow.”