Herbal medicine, also known as botanical medicine, phytotherapy or phytomedicine, is the use of plants for healing. The leaves, flowers, stems, seeds, roots, fruits or bark may be used and ancient scriptures show that the Roman, Egyptian, Persian and Hebrew people all used herbal medicine to treat diverse illnesses.

The only form of medicine of the majority of the world

Every global culture has its own herbal remedies based on local plants and knowledge passed on over generations. Some examples include indigenous Australian, traditional Chinese medicine, Ayurvedic (Indian) medicine, Native American and European remedies. According to WHO, although herbal medicine is classed as ‘complementary’ in most Western countries, it remains the only form of medicine widely available to most people globally.

Pharmaceuticals’ herbal medicine roots

Many modern prescription medicines have their roots in herbal medicine and herbs work in a similar way to many pharmaceuticals. For example, aspirin is derived from the bark of the willow tree, the anti-malaria medicine, quinine, is extracted from the bark of the cinchona tree, morphine is produced from the opium poppy and CBD oil is derived from the marijuana plant.

Plants contain a large number of naturally occurring chemicals (constituents) with different biological activity. While pharmaceutical medicines use just one active ingredient, herbalists use herbs in their complete form, retaining the balance of a variety of constituents contained in the plant. Plus, herbalists believe that plants can effectively treat many conditions with far fewer unwanted side effects that are often seen in conventional pharmaceutical treatments. However, herbs can be very potent and, if misused, they can cause serious adverse effects.

Regulation of herbal medicines

Medicinal products containing herbs are regulated in Australia by the Therapeutic Goods Administration (TGA). If ingredients are deemed higher risk due to toxicity, likely length of use, side effects, interactions or other features, they will be classified a registered medicine. In this case, the product will have the designation AUST R on the label. The product can be labelled a listed medicine with an AUST L label if deemed low risk.

Buyer beware

The TGA publishes safety alerts/advisories on its website about medicines of concern and advises consumers to exercise extreme caution in buying medicines over the Internet. This is because medicines bought from overseas may not meet the same standards as medicines approved in Australia; they may even contain unauthorised and potentially harmful ingredients.

The takeout

Herbal medicines have a very long history of use all over the world. Australian supplementary medicines are the most highly regulated in the word and a qualified health professional can provide useful guidance pertinent to individual needs.

Australia’s complementary medicines industry is evolving to meet the needs of consumers and the Covid pandemic has altered the choices Australians are making. Read more here.

The skin bumps and pimples that are acne are too familiar to many of us.

Acne vulgaris affects more than 90% of young Australians aged 16–18 years and it can lead to self-esteem and emotional issues. Many factors contribute to acne development including inflammation, excess sebum and keratin production, acne-causing bacteria, hormones, blocked pores, hormones, medications, stress, age, certain foods and more. Acne bacteria may turn a clogged pore into an inflamed pimple.

Acne lesions can increase the activity of pro-inflammatory factors on the skin (such as interleukin-1), which then trigger inflammation.

A range of treatments including gentle skin care for mild acne either unblock the sebaceous ducts or act as antibacterial agents.

Diet and nutrients may also help. Some researchers suggest that restricting refined carbohydrates, fast food, dairy, saturated fats and trans fats could be helpful. 

Dietary factors that may help alleviate acne include:

Paleolithic-style eating: Paleo diets are rich in lean meat, vegetables, fruit and nuts and low in grains, dairy and legumes has been linked with a reduced incidence of acne. 

Mediterranean-style diets: Rich in vegetables, fruits, wholegrains, legumes, fish and olive oil and low in dairy and saturated fats; this kind of eating may reduce the severity of acne.

Omega-3s: These are essential fatty acids (which means the body can't make them for itself). They have a potent anti-inflammatory action; regular consumption is linked to a reduced risk of acne. A deficiency of omega-3 fats is related to the promotion of acne. A randomized, controlled trial in 45 people with mild to moderate acne found that taking 2,000G of EPA and DHA supplements daily for ten weeks significantly decreased inflammatory and noninflammatory acne lesions.

Probiotics: These promote a healthy gut and balanced microbiome, which is linked to reduced inflammation and a lower risk of acne. Researchers concluded that the skin microbiome, or bacterial skin balance, has more to do with acne development than a single type of bacteria. Probiotic foods include sauerkraut, kimchi, pickles and kefir. 

Turmeric: The active ingredient in turmeric is anti-inflammatory and anti-microbial curcumin. Studies suggest that it may inhibit the growth of acne-causing bacteria.

Vitamins A, D, E and zinc: These play essential roles in skin and immune health and may help prevent acne.

September is Prostate Cancer Awareness month; the Prostate Cancer Foundation of Australia is asking Australia to get involved and help create awareness and raise the much-needed funds to assist in the fight against prostate cancer. The most common cancer in Australia sees 20,000 men diagnosed with prostate cancer each year, with close to 3,300 deaths. About the size of a walnut, the prostate gland surrounds the bladder and urethra. It continues to grow throughout a man's life. 

The prostate can become enlarged over the age of 50, a condition known as benign prostatic hyperplasia (BPH). Because of enlargement and inflammation, the flow of urine out of the bladder can become blocked, resulting symptoms can include the urge to urinate, waking up in the middle of the night to urinate, painful ejaculation and erectile dysfunction. There may also be a feeling of fullness in the bladder and incomplete emptying. BPH can also cause bladder, urinary tract or kidney problems.  

Although the development of BPH is not completely clear, testosterone may play a role. It may be that a metabolite of testosterone, dihydrotestosterone, builds up in the prostate, causing it to grow. 

As well as regular medical checks and consulting a doctor if symptoms develop, enjoying a healthy mixed diet is essential for prostate health. So:

Get into and stay in a healthy weight range

Exercise regularly 

Cut down on red meat and saturated fats

Moderate alcohol intake

Certain nutrients are also thought to contribute to prostate health.

Add omega-3s

Try to put fish on your dish twice a week or more. Oily fish, including salmon, mackerel, sardines and tuna, are rich in omega-3 fatty acids which are powerful anti-inflammatories. All fish contains some omega-3s, though so white fish, canned tuna and seafood are good choices, too. Try oysters, calamari, prawns and crab are rich in zinc. A normal prostate has the most concentrated levels of zinc in the body. Research shows that prostate tissue from men with BPH had significantly less zinc than normal prostate tissue. It is not clear if prostate problems cause the depletion of zinc, or if lower levels of zinc contribute to prostate health problems.

Berries and more

Berries, citrus, and other fruits are packed with antioxidants and vitamin C; these battle free radicals, which are by-products of normal body reactions. Over time, the build-up of free radicals can cause damage such as inflammation which is an important factor related to prostatic enlargement. 

Don’t skimp on veggies

Vegetables provide a whole range of vitamins, minerals, antioxidants and phytochemicals. Cabbages, broccoli, bok-choy, cauliflower, onions, and garlic contain sulphur and help to fight inflammation.

Love lycopene

One of the greatest prostate-protecting superstars is tomatoes. The pigment that gives them their rich, red colour is the powerful antioxidant lycopene. Cooking tomatoes with olive or coconut oil makes the lycopene easier for the body to absorb. Watermelon is also lycopene-rich.

Turn to turmeric

A cousin to ginger, turmeric gives curry and mustard their deep yellow colour. It has been used in India as a spice and medicinal herb for thousands of years and now, science has proven turmeric's medicinal qualities. Curcumin is turmeric’s active ingredient and consuming it with piperine in black pepper enhances its absorption by a massive 2,000%. Most Australian curcumin supplements contain piperine. High doses of curcumin over a gram per day are needed for the medicinal results seen in studies.

It is essential to discuss any concerns about regarding prostate health with a medical professional as soon as possible.

The truth is that where it comes to beating inflammation, there is no one single remedy but healthy, lifestyle choices can help.

So, anyone for salmon, spinach and turmeric-pepper tomatoes?

By guest contributor Michelle Boyd MHSc WHM, GradCert HEd, BHScNat, FNHAA Naturopath and Herbalist, University Lecturer, Clinical Educator & Author.

Michelle Boyd, Naturopath, Herbalist, Lecturer, Clinical Educator and Author.

Menopause is a natural stage of life; it is not a disease. Managing menopausal symptoms is only one part of the big picture in supporting a woman’s adjustment through mid-life changes. Ideally, planning for menopause should begin long before it starts.

The menopausal transition usually occurs from 45 to 55 years of age and may take a woman 5 to 10 years to transit menopause, with this stage of fluctuating hormones (and hence irregular menstrual cycles) referred to as perimenopause¹. Perimenopause is recognised by many as a time of ‘hormonal chaos’ during which up to 80% of women suffer from both physical and emotional symptoms (60% mild to moderate; 20% severe), including hot flushes and sweats(mostly), anxiety/depressed mood and insomnia.²

Hot flushes

Menopausal hot flushes are thought to be hormonally driven, however they are also influenced by stress and diet (blood sugar fluctuations). No matter what the cause, it’s all about the ‘bothersome’ factor – whether women have 2 or 20 hot flushes a day, if it’s ‘bothersome' enough for them to seek help then they need relief!

The most reliable herbal relief for hot flushes is found with Actaea racemosa (Black cohosh). Most recent Actaearacemosa studies^3,4,5 involving 1200+ menopausal womendemonstrated statistically relevant reduction of major menopausal symptoms especially the incidence and severity of hot flushes with results seen within 2-4 weeks, with continued improvement shown over 3 and 9 months.

Stress/diet related factors that may exacerbate hot flushes also need to be identified. Erratic eating behaviour plays havoc with blood sugar levels promoting the incidence/severity of hot flushes. Menopausal women need to eat (less) more regularly and think ‘paddock to plate’:Combine good quality protein with colourful plate of antioxidant rich fruits and vegetables

Relax before meals and eat dinner (early) at the table

Alcohol promotes hot flushes – reduce/stop intake

Anxiety and stress

Midlife women have many sources of anxiety and stress -juggling work with life, bringing up teenagers, caring for grandchildren and/or aging parents and their own ageing. 

Anxiety and stress can be part of the menopause picture and/or result from a very busy, caffeinated and stressful mid-life! Either way, these women need nervous system support, e.g., herbal Hypericum perforatum (St. John’s wort) is shownto relieve stress and anxiety, improving midlife mood – as does reducing caffeine intake!

Insomnia

Women can suffer hot flushes and/or sweats 24/7 which can cause insomnia. Alternatively, insomnia may be due to worrying about ‘midlife stuff’ becoming tired, cranky and frustrated – more midlife moodiness! Reducing the incidence/severity of hot flushes/sweats and promoting a good night’s sleep will help resolve her suffering and Valeriana officinalis (Valerian) and Humulus lupulus (Hops)combination, mimic the body’s natural sleep hormone (melatonin) promoting a restful good night’s sleep.⁶

Silent changes

Post-menopausal women may continue to experience menopausal symptoms; however, it is the ‘silent changes’ due to the decline in the ‘protective effects’ of oestrogen that require far more important attention. Cardiovascular disease (CVD) is the leading cause of death in post-menopausal women and cardiovascular markers like increased body weight (especially abdominal fat), high blood pressure and high cholesterol, all increase in post-menopause.⁷ Lifestylechanges are essential to increase longevity and decrease the risk of osteoporosis and CVD. Healthy eating and regular exercise are most important to manage weight and prevent disease. 

Healthy heart

A diet rich in antioxidant/anti-ageing culinary herbs and spices have been shown to be beneficial for cardiovascular health.⁸ Most notable is turmeric, the ‘spice of life!’ with antioxidant/anti-inflammatory properties providingtherapeutic benefits for various conditions ailing menopausal women.  Others include ginger, cumin, marjoram, cardamom, garlic, cinnamon, oregano and rosemary.

Periodic testing of blood pressure and blood lipid (fat) levels (importantly triglycerides) is recommended for menopausalwomen as is bone mass density (BMD).

Healthy bones

Menopause is an important time to check BMD to identify any health issues early. On average, it is estimated women will lose up to 10% of their BMD in the first 5 years post menopause. Promoting healthy bones requires both regular exercise and adequate vitamin D levels and calcium intake.⁹

Menopausal women require 1300 mg/day of calcium, preferably from low calorie dietary sources (which will also contain other healthy nutrients),¹⁰ with a calcium supplement (maximum 500-600 mg per day) to top up the difference if need be. 

Low levels of vitamin D are commonly seen in menopausal women. Vitamin D is naturally produced in our skin when exposed to ultraviolet sun light. Osteoporosis Australia’s website www.osteoporosis.org.au provides a vitamin D sunshine map to help you identify the best time/duration depending on location/time of year for optimal exposure and regular intake of vitamin D3 supplement is beneficial for those with inadequate levels.

Exercise

Regular exercise is important for menopausal heart and bone health and there are several reasons why.¹¹

Upright weight-bearing activity promotes strong healthy bones. 

Inner core strength exercise helps maintain balance to help prevent falls.

Improving reflexes promotes quicker response to help break falls. 

Menopausal women need to consult their doctor and a qualified exercise specialist to establish their individual needs.  

Exercise builds muscle cells providing benefits for metabolism and improved energy to enjoy midlife and beyond!  

In closing …

Many menopausal women (including myself) soon realise their menopausal symptoms just don’t go away overnight and some of us must endure them for many years. In knowing this, our focus becomes that of finding efficacious, clinically proven, natural treatments with good safety track records.Look for them – they’re out there 

References

1. Menopause Symptoms, Signs, Treatment, Definition (medicinenet.com)

2. Symptoms of menopause | Jean Hailes

3. Lopatka L et al. Black Cohosh in the Treatment of Menopausal Complaints – Results of an Observational Study with Cimifemin Uno. Journal of Menopause(English version) 2007; 2:16-21.

4. Schellenberg R et al. Dose-Dependent Effects of the Cimicifuga racemosa Extract Ze 450 in the Treatment of Climacteric Complaints: A Randomized, Placebo-Controlled Study. Evidence-Based Complementary and Alternative Medicine. 2012. doi: 10.1155/2012/260301. 

5. Drewe et al. The effect of a Cimicifuga racemosaextracts Ze 450 in the treatment of climacteric complaints – an observational study. Phytomedicine.2013; 20:659-666.

6. Koetter U et al. A Randomized, Double Blind, Placebo-Controlled, Prospective Clinical Study to Demonstrate Clinical Efficacy of a Fixed Valerian Hops Extract Combination (Ze 91019) in Patients Suffering from Non-Organic Sleep Disorder. Phytotherapy Research. 2007; 21:847-851.

7. Menopause | Health and wellbeing | Queensland Government (www.qld.gov.au)

8. Iyer A et al. Potential Health Benefits of Indian Spices in the Symptoms of the Metabolic Syndrome: A Review. Indian Journal of Biochemistry & Biophysics. 2009; 46:467-481.

9. Menopause and osteoporosis - Better Health Channel

10. Calcium - Better Health Channel

11. Grindler NM & Santoro NF. Menopause and exercise. Menopause. 2015; 22(12):1351-1358. 

By guest contributer, Sarah Culverhouse, Head of Education at  Fusion Health.

Naturopath and Head of Education at Fusion Health, Sarah Culvershouse, talks herbs, hormones and tradtional Chinese Medicine. 

Traditional Chinese medicine (TCM) has an interesting understanding of the changes that occur in a woman’s body during menopause. The insights offer a window into some of the core concepts of TCM as well as traditionally used symptom relief strategies for women experiencing menopausal symptoms.

Menopause is a time of Yin and Yang imbalance

The concepts of Yin and Yang and the key role that balance and harmony play in health and wellbeing¹ is an aspect of TCM that most of us have some awareness of. These days, the familiar Yin-Yang symbol can be seen around the world, featured on everything from t-shirts and surfboards – and even the Fusion Health logo!

In summary, TCM teaches that Yin and Yang are two opposing forces that exist in an ever-changing relationship. One may dominate the other under certain circumstances, but as long as they’re continuously returning to balance, optimal health and wellbeing will be maintained.

In TCM, all Yin and Yang in the human body is traditionally believed to arise from the Kidney organ-meridian system, which is also regarded as governing all aspects of reproductive health and function – including the menopausal transition¹.

During menopause, it’s traditionally understood that Kidney Yin becomes deficient relative to Kidney Yang².

Yin has cooling and moistening properties, so when Kidney Yin is deficient, symptoms can develop that are characterised by heat (such as hot flushes and sweating²) and lack of moisture (such as vaginal dryness).

On the other hand, Yang is heating and drying, so as it becomes more dominant or hyperactive in comparison to Kidney Yin, heat-related menopausal symptoms worsen, and the fluids in the body begin to dry up.

In TCM, this symptom pattern is known as ‘internal heat in Yin deficiency’ or ‘deficiency heat’¹.

Traditional Chinese Herbal Medicine for Menopause

Anemarrhena: traditional cooling herb

When the Kidney Yin deficiency pattern described above is present, anemarrhena is traditionally used to relieve hot flushes, night sweats and vaginal dryness in TCM.

It’s traditionally regarded as having cooling properties and the ability to moisten dryness, so is traditionally used in TCM to nourish Yin and cool deficiency heat.

Dong quai: traditionally used to relieve menopausal hot flushes

Dong quai is traditionally used to relieve menopausal symptoms, including hot flushes in TCM, and is also traditionally taken as a blood tonic.

Yoga for menopausal women

Research suggests that practising yoga might help women who are peri-menopausal or post-menopausal manage both vasomotor symptoms like hot flushes and night sweats, and psychological symptoms such as mood swings.

In particular, regular yoga may lead to a small-to-moderate reduction in the severity of hot flushes – but you’ll need to develop a regular practice, as these effects don’t occur in the short-term, according to research published in the journal Complementary Therapies in Medicine.

References:

1.    Liu, Z. & Liu, L. (Eds.) (2009) Essentials of Chinese Medicine (vol 1) Springer London.

2.    Bensky D and Barolet R. Chinese Herbal Medicine Formulas & Strategies. 1990. Eastland Press.

3.    Shepherd-Banigan, M. et al. Complement Ther Med, 2017;34156-64

Asthma is a chronic lung disease; symptoms include coughing, shortness of breath and wheezing. Caused by inflammation and swelling in the airways of the lungs, severe asthma attacks can be dangerous and even life-threatening.

The incidence of asthma seems to be higher in western countries, which can be rich in refined sugar, fats, and processed foods. Poor diet may, in turn, be linked to widespread deficiencies of certain nutrients, including vitamins. Focusing on fresh vegetables and fruit may help. There is no single superfood or nutrient that helps to improve asthma symptoms. Still, a diet rich in vegetables and fruits may help your symptoms and whole-body health.

As well as taking prescribed medicines and following advice from a healthcare professional carefully, some dietary factors and forms of exercise, movement and breathing may help. 

Vitamin D

Fat-soluble vitamin D is also known as the sunshine vitamin because most of our vitamin D is derived when the sun reacts with a cholesterol-like substance in the skin. Essential for bone health, vitamin D also affects the part of the immune system that identifies specific disease-causing microorganisms. Some of these microorganisms, such as respiratory viruses, may trigger asthma attacks.

To boost your vitamin D levels, practice safe sun. Dietary sources include dairy, eggs, fatty fish and UV treated mushrooms.

Vitamin C

Unlike most mammals, humans can't make water-soluble vitamin C, but all body cells need this water-soluble vitamin. A daily intake is important because the body can't retain large amounts. It's antioxidant and has anti-inflammatory properties that reduce oxidative stress, including placed on tissues in the airways. Vitamin C might reduce an individual's hypersensitivity to asthma triggers while reducing inflammation and hypersensitivity in a similar way that prescribed inhaled steroids work, according to researchers. 

Find vitamin C in vegetables and fruits. Enjoy seasonal and raw, when possible, to retain as much vitamin C destroyed by heat and exposure to air. 

Omega-3 fats

Several studies link fish and fish oil consumption - omega-3s - with a lower risk of asthma in children and young adults. Other research suggests that taking fish oil during the third trimester of pregnancy might cut children's risk of developing asthma. A study from Copenhagen found that consuming fish oil supplements could reduce childhood asthma rates.

Find omega-3s in fatty fish such as fresh tuna, salmon and sardines. Canned fish contains less omega-3s but is still a healthy option.

Exercise and yoga

Regular physical activity may help to reduce asthma symptoms by improving your lung health. As well as aerobic exercise and weight training to building muscle strength, you may want to add yoga into the mix. The ancient Indian practice of yoga involves held postures and movements performed with breathing techniques. Yoga aids relaxation and enhances fitness. Regular practice may help by improving posture and opening the chest muscles, which encourages better breathing.

Research suggests that yoga may improve quality of life and asthma symptoms to some extent. Always talk to your doctor about your exercise options. 

In a recent article in Australian Prescriber: ‘The safety of commonly used vitamins and minerals’, dated 2 August 2021, Dr Geraldine Moses says that: "Dietary supplements have a range of potential risks and few benefits” and that “Consumers should be aware that there is no case for vitamin or other supplements in normal healthy people who are not pregnant or breastfeeding.” CMA respectfully disagrees.

According to researchers writing in the American Journal of Nutrition, Enhancing iron absorption. 100 mg of vitamin C may improve iron absorption by 67%.

Risks of dietary supplements - Interactions do exist, in a similar way that foods can also interact with drugs. Fortunately, decades of research have shown there are only a small handful that are clinically significant.  

Dose is also important - just like every medicine when the dosage is too high, side effects my result. Geraldine Moses fails to mention that the very high doses required to result in side effects are clinically challenging to consume and unlikely to occur under normal supplemental intake.

Manufacturers of Australian complementary medicines recommend appropriate dosages on the labels. The TGA requires at least 25% of the recommended daily intake to make statements about the role of vitamins and minerals in the body.

Contrary to Dr Moses’ statement: “Unlike conventional medicines, manufacturers of vitamins and minerals are not required to provide warnings of their potential side effects,” warnings ARE required on supplement labels or before point of purchase.

More than 25 mandatory warnings apply to a variety of nutrients.

Increasing health literacy

Geraldine Moses does not acknowledge the health literacy of the Australian public either; CMA believes growing understanding is inspiring people to take increasing control of their health. Using individually-sought or shared research with the advice of health professionals (from pharmacists and integrative GPs to nutritionists, dentists and more) and by paying close attention to the individual effects that supplements are having, an increasing number of people are using nutritional supplements as an essential part of their therapeutic and preventive approaches to good health.

Geraldine Moses says there a few benefits of dietary supplements. Again, CMA disagrees and we present a small number of examples.

Vitamin D

“Some people may not be able to spend enough time in the sun or may not be able to produce vitamin D easily. Health professionals may recommend vitamin D supplements after considering individual circumstances, including whether vitamin D deficiency is present and how severe it is.”

According to NPS Medicine Wise, 

Vitamin B12

According to HealthDirect: “Vitamin B12 deficiency can be caused by not eating enough foods that contain Vitamin B12, especially meat and animal products. More often it is caused by the body not being able to absorb the Vitamin B12 properly.”

According to Harvard Health: “Older adults can have difficulty absorbing vitamin B12, and  have a lower threshold when checking this level; if someone is taking an acid-reducing medication, it is very likely that they will become deficient in B12, as well as iron, vitamin D, and calcium, among other things. This cohort may very well benefit from a quality multivitamin.”

Iron deficiency anaemia

According to Australian Prescriber: Correcting iron deficiency anaemia: “Oral iron replacement is the most appropriate first-line treatment in the majority of patients.” 

Vitamin C

According to researchers writing in the American Journal of Nutrition, Enhancing iron absorption. 100 mg of vitamin C may improve iron absorption by 67%. Thus, vitamin C may help reduce the risk of anaemia among people prone to iron deficiency.

B vitamins

According the researchers, “B complex deficiency in alcoholism primarily arises due to malnutrition or intake of a diet deficient in necessary vitamins and minerals. Additionally, alcohol consumption exacerbates the effect of a poor diet and reduces absorption of B vitamins.

Consuming 24g alcohol (240ml red wine or 80ml vodka) per day for two weeks leads to a decrease in folate and B12 levels in healthy individuals.”

Poor nutritional status

The long-term consumption of poor dietary quantity (e.g., due to loss of appetite) or quality (e.g., restrictive, unbalanced, or low-nutrient dense diets increase the risk of poor nutritional status. In older age groups, many changes, including physical, physiological, and psychosocial factors make it more difficult for nutritional needs to be met, leading to shortfalls in nutrients.

Contrary to Dr Moses’ comments, the Australian Bureau of Statistics reports that a number of Australians are not meeting vitamin and mineral requirements.

Vitamins

Approximately one in twelve (9%) adult females (aged 19 and over) did not meet their requirements for folate (dietary folate equivalents) based on their intakes from foods.

Approximately 7% of males and 16% of females had inadequate thiamine intakes.

Approximately 17% of males and 14% of females had inadequate usual intakes of vitamin A (as retinol equivalents)..

Three in every ten people aged two years and over had an inadequate intake of vitamin B6.

The proportion of females aged 14 years and over with inadequate usual intakes of vitamin B12 ranged from 5 to 8% for different age groups.

Minerals

Three in four females aged two years and over (73%) did not meet their calcium requirements, compared with one in two males of the same age group (51%).

One in eight people aged two years and over had inadequate usual intakes of iron. The prevalence of inadequate intakes was highest amongst females aged 14-50 years, with nearly two in five having inadequate iron intakes.

One in three people aged two years and over (37% of males and 34% of females) did not meet their requirements for magnesium. Inadequate intakes of magnesium were more common in those aged nine years and over, with 61% of males aged 14 to 18 years consuming less than their requirements for magnesium, and 72% of females of the same age.

More than one in three males (37%) and one in ten females (9%) had inadequate usual zinc intakes. The greatest prevalence of inadequacy was among males 71 years and over, where 66% had inadequate zinc intakes.

Half of all Australians take expensive vitamin and mineral supplements, but they are not always harmless shout the headlines in today’s newspaper, but is this sweeping statement factually correct? Is the researcher applying this broad declaration to every supplement available in Australia?

The audacious blanket statements made in the published article by Geraldine Moses are just untrue.

Australia has the most highly regulated environment in the world for complementary medicines’ quality and safety. A manufacturer’s use of the AUST L or AUST R number on the label proudly displays the fact that the product has been regulated to minimise the possibility of side effects. Side effects are rare and all listed in the Database of Adverse Event Notifications (DAEN).

Dr Geraldine Moses from the School of Pharmacy at the University of Queensland has flagged potential harms associated with using dietary supplements in the journal Australian Prescriber and subsequently reported in The Courier Mail and other news outlets. Here are ten questions that arise from her latest and well-worn attack on complementary medicines.

1. “One reason for the persistent popularity of vitamins and minerals is the perception that they are harmless.”

Is the author suggesting that people take supplements because they are harmless and not for their health benefits? Indeed, this is a blanket insult to the intelligence of the public.

2. “Like all medicines, supplements can cause potential harm. Still, unlike conventional medicines, manufacturers of vitamins and minerals are not required to provide warnings of their potential side effects, drug interactions or risks from an overdose.” 

Interactions exist in a similar way in which foods can also interact with drugs. Fortunately, decades of research have shown there is only a small handful that are clinically significant. The industry produces interaction checkers for healthcare Practitioners. For example, Blackmores Institute produces one that is reviewed by academics at Sydney University and offer practical training for pharmacists via their training portal.

Dose matters - like every medicine, too high, and you get side effects. Geraldine Moses fails to mention that the high doses required to result in side effects are clinically challenging to consume. Manufacturers of Australian complementary medicines recommend dosages on the labels.

Geraldine Moses does not acknowledge the health literacy of the Australian public, which CMA believes is inspiring people to take increasing control of their health. Using individually-sought or shared research with the advice of health professionals (from pharmacists and integrative GPs to nutritionists, dentists and more), more and more people are using nutritional supplements as an essential part of their therapeutic and preventive approaches to good health. The industry takes the training of health care practitioners and pharmacy assistants seriously, with a significant focus on these areas.

3. “Vitamins and mineral supplements are not all they are cracked up to be and can bring false hope and disappointment.”

We are not sure which supplements the researchers believe: “not all they are cracked up to be.” Nor which supplements bring false hope. The author comments on a diverse range of the supplements available in Australia, from fish oils to probiotics, iron supplements to vitamin D, turmeric to CoQ10; it is unclear just what Geraldine Moses is referring to.

Australians choose different supplements for many reasons, and a myriad of evidence supports their nutritional health benefits. Making blanket statements is not just inaccurate; it is unworthy.

4. “Vitamin supplements may be a waste of money.”

Another broad-ranging and vague statement, which is much less helpful than a definitive statement, might have been.

5. “Eating too much of certain antioxidants may increase mortality rate.”

It would be interesting to know which ones are being referred to and for which group of society.

6.“The expensive products are big sellers and used by almost half of all Australians.”

Over seven out of 10 Australians use complementary medicines. Just as any products that have been researched and formulated, regulated and distributed, costs are incurred. CMA does not and cannot put a price on a person’s preventive and therapeutic health choices.

7. “Manufacturers are not required to provide warnings of potential side effects, drug interactions or risks from overdose.”

The label warnings on Australian complementary medicines clearly state dosage instructions and consult a health professional if symptoms persist. Certain complementary medicines can only be purchased via health professionals, including pharmacists, naturopaths and dentists. Discussing the use of medicines – including complementary medicines – is an essential part of effective health literacy.

As already mentioned, the industry holds training sessions for pharmacy staff and health professionals. It encourages free-flowing and ongoing communication to protect and support customers’ health while promoting the education of healthcare professionals and staff.

8. “What many people don’t realise is that high doses of some supplements can be dangerous.”

Again, improving health literacy and the encouragement of dynamic and robust communication with health professionals is vital. Consumers are also strongly advised to read and abide by the warning statements on the labels. The complementary medicines industry is in the business of health protection. It will do everything possible to ensure customers understand the medicines that they are using and that they obtain the advice of a health professional to guard their wellbeing at every stage.

9. “Another thing to remember is that the same vitamin or mineral can be in multiple different products, so a person can accidentally overdose if those products are all taken together.”

Once more, transparent and honest dialogue with health professionals and individuals is vital. The risk of overdose is small; however, taking numerous supplements with the same ingredients can be dangerous.

Labels on Australian complementary medicines have clear guidelines on dosage and instruction. These labels provide relevant consumer warnings for well-established information. Consumers should read and adhere to the dosage directions and warnings on the label and talk to a healthcare professional should they feel overdosing on supplements or prescription medicines, or over-the-counter medicines.

10.“Vitamin and mineral supplements can be important to treat certain illnesses or nutritional deficiencies. For example, vitamin B3 can be used for high cholesterol, and folic acid can be used in pregnancy to prevent birth defects. When used for general wellness, however, their risks may outweigh their benefits.”

CMA must question this incredibly bold statement that the use of vitamin and mineral supplements for general wellness that the risks may outweigh the benefit. Do the authors disagree with the use of iron supplements to treat anaemia? Or vitamin D supplements for up to 40% of Australians with diagnosed deficiency? Or B12  for the increasing number of people choosing a plant-based diet? Or fibre supplements for the easing of constipation and more? This audacious blanket statement is incorrect.

CMA reiterates the need for consumers to communicate with their doctor and pharmacist when choosing complementary medicines. Whether the consumer has a medical condition or risk factor or is taking specific prescription or over-the-counter medications are important factors that should be considered.

CMA is justly proud of the Australian complementary medicines industry. Increasing knowledge and understanding of customers, growing education on complementary medicines and pharmaceutical medicines for healthcare professionals, including pharmacists, pharmacy assistants and more; this, teamed with the increasing demand for high-quality Australian supplements, has resulted in an Australian success story. Ours is the most highly regulated environment for complementary medicines globally, and it means that consumers can be confident about the quality and safety of Australian complementary medicines.

The Australian public is more educated about health than ever before and more than seven out of ten of us now use some form of complementary medicine to support our health. This diverse range of treatments include:

• herbal medicines

• vitamin, mineral and nutritional supplements

• probiotics

• Ayurvedic and traditional Chinese medicines and more.

“Australian complementary medicines are among the safest in the world, manufactured to the highest pharmaceutical standards."

A recent newspaper story reports that as well as liver toxic pharmaceutical drugs such as paracetamol and antibiotics, other pharmaceutical drugs and supplements may be involved in liver damage in a small number of cases.

Where referring to complementary medicines, the researchers do not reveal the ingredients in the products or whether these products are single- or multigradient formulations. Further, we are not told whether these products are from Australia or bought from overseas; all of these factors make accurate commentary and response difficult.

What researchers do reveal, is that the products fall into the categories of muscle growth in males and weight-loss in women.

With regards to bodybuilding supplements in males, it is mere speculation as to whether the products examined contained anabolic steroids. There are no Australian complementary supplements listed on the Department of Health’s Therapeutic Goods Administration (TGA’s) Australian Register of Therapeutic Goods that contain such ingredients. For females, the story cites weight-loss supplements. Again, the affected products, their source and the ingredients investigated are not provided, making accurate commentary difficult.

It is known that both bodybuilding supplements and weight-loss supplements are more likely to be imported for personal use and when tested are more likely to include ingredients that are not declared on the label.

Look at the label
Complementary medicines including herbal medicines that are supplied to consumers in Australia (with an AUST L or AUST R number on the label) are regulated to minimise the possibility of liver associated side effects including the absence of herbs with well-known
effects. In those where reactions are very rare and without known cause, they come with consumer safety information or warnings, similar to pharmaceutical medicines that pose a similar rare risk of liver effects.

CMA reiterates the following factors to support health when choosing complementary medicines.

1. Beware of products purchased from overseas that may contain unlabelled and potentially harmful ingredients.
Some overseas-based products may be adulterated and non-compliant with Australian
regulations. The ingredients are may either not be listed or their concentrations inaccurately reported.

2. Trust in Australian made
Australia has the most highly regulated environment in the world for complementary medicines quality and safety. Manufacturing is required to adhere to pharmaceutical standards under principles of Good Manufacturing Practice (GMP) and products meet specific guidelines set by the TGA.

In the Australian regulatory system, all complementary medicines (bearing an AUST L or AUST R number) that contain herbs must undergo identification tests to ensure each herb is what it says it is. This stringent
governing has resulted in discerning consumers choosing Australian-made products and has made the Australians' complementary medicines industry a national and worldwide success story.

3. Follow the instructions on the label
Labels on Australian complementary medicines have clear guidelines on dosage and instruction. These labels provide relevant consumer warnings for well-established information. If unsure of suitability or if other health concerns exist, consumers should seek the help of a healthcare professional before use.

4. Better health literacy for all
The researchers in the above story note that almost half the patients with supplement-induced liver damage were of non-European ethnic backgrounds. They called for more culturally appropriate community education about the risks of supplements. CMA agrees that more education is necessary regarding health literacy among the population including the use of all medicines
particularly in regards to purposeful overconsumption or potentially higher risks of imported products not regulated under the therapeutic goods scheme in Australia.

CMA welcomes greater investment in improving heath literacy. Recent data tells us that only
39% of the population find it always easy to understand health information well enough to know what to do¹.It is well known that people with low health literacy are more likely to have worse health outcomes overall and adverse health behaviours, including ability to self-manage care.

Further, targeting health literacy programs at diverse population groups has the potential to reduce health inequalities.

Why it is difficult to agree with Dr Harvey

Self-professed and very vocal critic of complementary medicines and the TGA, Dr Ken Harvey, commented that the study only examined severe cases of supplement-induced liver harm saying that the actual rate of damage was likely to be much higher. This is also difficult to agree with since the studies ingredients are not stated and because all recorded events to complementary medicines are reported and available to the public on the TGA’s Database of Adverse Event Notifications (DAEN).

The published article cited 115 cases of paracetamol induced liver injury in the same time period, and it is not clear whether Dr Harvey also believes that the rate of damage of this substance is also much higher than stated in the study, or which information warrants these types of claims.

Australia takes each report extremely seriously

“Australian complementary medicines are among the safest in the world, manufactured to the highest pharmaceutical standards. We lead the world in adverse reporting process and take each and every single report extremely seriously to ensure consumer safety. CMA welcomes detailed investigation and examination by the research community to inform and strengthen our high-quality standards,” ends Carl Gibson.