The story of how herbs can support immune health is starting to make its way through the medical community in a more focused manner, said Langhorne, PA-based integrative physician Dr Wendy Warner. Warner was conventionally trained, but came to be dissatisfied with most of what she had been taught in medical school, with its emphasis on disease care via pharmaceuticals.
“I am a conventionally trained OB GYN,” Warner told NutraIngredients-USA. “I was interested in botanicals anyway so I started going to professionally herbalists conferences. I eventually founded the American Holistic Medical Association. That was the board that certified MDs and DOs in holistic medicine for about 15 years.
“When I first started going to the conferences it was mostly professional herbalists. Now when you go its about a 50/50 split between herbalists and health care practitioners,” she said.
Reductionism vs synergy
One of the complicating factors for the use of herbs in many medical practices is their complexity, Warner said. There are many different herbs to choose from, and many different dosage forms. And herbs contain dozens or hundreds of different chemicals of interest, and trying to identify the key bioactive and concentrate it doesn’t always work as intended, in her opinion. Her view runs counter to the reductionist, pharmaceutical-style approach that has dominated the dietary supplement development landscape in recent decades.
“I think what happens in the supplement industry is we pull out one or two chemicals out of a mushroom or a plant and we think we have made an improvement. It’s often the case that if you separate them, they don’t work as well. There are a few herbs where we know a lot about their actions but others where we know very little,” Warner said.
“It has been proved in the past that we have chosen the wrong thing as the primary active ingredient. That was true of St. John’s Wort thirty years ago,” she said.
So Warner said it’s important to trust in the fact that the ‘synergy’ of active ingredients often mentioned by professional herbalists is a real effect, albeit an uncomfortable one for researchers who want a clearly defined method of action. Warner said dosing and dose form is critical for the successful use of herbs. The problem is inconvenience, and the offensive taste of many herbs, which all add up to challenges in patient compliance, one of the things that putting herbs into capsules was meant to address in the first place.
“Take echinacea, for example. Echinacea is fine if you actually use it correctly and most don’t. The dosing of what’s on the market is way below what you actually need. I recommend echinacea be used both as a tincture and a tea. If you use it the way most companies suggest you are going to get way too low a dosage,” Warner said.
“The problem with herbs is they don’t taste good, most of them, so many people don’t want to take a tincture or a tea. Traditional herbalists generally speaking will prescribe both tinctures and tea so you are getting many different compounds,” Warner said. “There are some companies like Gaia Herbs (full disclosure: Warner is a member of Gaia’s Scientific Advisory Board) that made very concentrated liquid extracts of herbs.”