The Risks of Herbal Treatments

Many people feel that traditional herbal products are more “natural” and safer than conventional drugs. However, some herbal products may have the same actions and effects as prescription medications resulting in harmful drug interactions or side effects. Unlike prescription and over-the-counter medications, herbal products and other dietary supplements do not need to be proven safe or effective before they are sold. Herbs and supplements are essentially crude drugs with the potential for both beneficial and harmful effects.

Herbal products, dietary supplements or very high doses of vitamins or minerals can have dangerous drug interactions and side effects, just like prescription and other nonprescription products. Side effects may reflect the purity of the preparation or additives. Stop taking herbal products and contact your health care provider immediately if side effects, a rash or signs of an allergic reaction occur.

In some cases, the herbal content of a product is considerably more or less than the strength listed on the label. While most herbal products are safe, some products have been found to contain pesticides, heavy metals, toxic herbs or prescription medications. For this reason, it is recommended that only high-quality products be used.

Be safe. Talk with your doctor earlier rather than later. Your doctor can help determine if there are any dangerous side effects or drug interactions and help determine the right dosage for you. As with all medications, more is not better and can lead to serious illness and death.

Selecting Herbal Treatments

Many people ask about dietary supplements to help improve memory and cognition such as ginkgo, ginseng, turmeric, and some specific products like Prevagen, Focus Factor and Axona. Currently there is no strong data to support the use of these supplements to help improve memory and cognition or to treat dementia. Many of these supplements have side effects and drug interactions. Please discuss with your healthcare providers before starting any supplement, herbal or vitamin to ensure their safe use.

If you are considering an herbal treatment, here are a few questions you should ask first:

• Is the product manufactured in the United States?
• Is the manufacturer well known and reputable? (Ask your pharmacist)
• Does the label list the name and form of the herb(s), the amount of the herb(s) in each dose in milligrams or grams, a lot number, and an expiration date? If you choose to use products brought in from other countries, read the label carefully with your pharmacist. Watch out for names of prescription drugs such as ephedrine and phenobarbital, which have been found in herbal products.
• Does the label or product information list a toll-free number you can call for more information?
• Call and ask how the raw herbs are accurately identified and how the product is tested for purity and potency. Some manufacturers will send a copy of their analysis to you and/or your physician, nurse or pharmacist. An independent laboratory (ConsumerLab.com) has tested some herbal products for purity and potency. Check their website and select an approved product or a manufacturer that clearly provides quality control.
• Have you discussed the possible benefits and adverse effects of the product with your pharmacist and/or physician?

Ingredients to Avoid

• Heavy metals: Excessive amounts of arsenic, lead and mercury have been found in some herbal products. Some, but not all, herbal product manufacturers have their raw herbs tested for heavy metal content.
• Prescription drugs: Prescription drugs such as phenobarbital, ephedrine, chlorpheniramine, non-steroidal anti-inflammatory drugs, benzodiazepines, corticosteroids and methyltestosterone have been found in some herbal products, most often those manufactured overseas.
• Misidentified herbs: The fact that some herbs can cause serious toxicity is well documented. The identification of raw herbs is traditionally made on the basis of appearance, taste, smell and feel. This may not be sufficient when the desired herb closely resembles a toxic botanical. In these instances, chemical analysis is required.

Medical Cannabis (Marijuana)

Medical cannabis or medical marijuana for dementia is not a cure, but it has been used to help manage difficult behavior (e.g., agitation, aggression), mood and pain. It is usually tried after non-drug treatments (e.g., physical therapy, music therapy, aquatic therapy, regular scheduling of activities, addressing or minimizing environmental factors such as temperature or noise and social factors such as how to talk to and engage the patient, introducing them to new caregivers or routines) and drug treatments (e.g., antidepressants, analgesics, antipsychotics) have failed.

The challenges with medical cannabis/marijuana are:

• Finding the right content and potency of CBD/THC
• Working with a good dispensary and prescribing physician
• Close monitoring of side effects as they trial different doses, formulations and concentrations of marijuana

There are hundreds of products to choose from, but it is best to try a product with higher concentrations of CBD than THC (THC has psychoactive properties). Medical cannabis/marijuana comes in tinctures (oily liquid, best mixed in oily foods or liquids), gummies, chocolates and berries and also topical preparations (topicals might be easier to give, but they might not be as effective due to absorption issues). It will likely require experimenting with different products and doses to find an effective product, and it could be that medical marijuana just won't help.

Side effects to be concerned about include drowsiness, dizziness, possible increased risk for worsening cognition and falls, elation and weight gain (although this may be desirable in some people). Cost (these products are expensive) and access may be issues too. In what we have observed in patients so far, it seems to be helpful for some and not for others, and side effects have been mild (so far).

CAM Resources

• National Center for Complementary and Integrative Health at the National Institutes of Health (NIH)
• The Office of Dietary Supplements (ODS) at the National Institutes of Health (NIH)
• NIH Research on Marijuana and Cannabinoids from the National Institute on Drug Abuse
• Natural Medicines: An international research collaboration that collects and synthesizes data on complementary and alternative therapies.
• ConsumerLab.com: Provider of independent test results and information on health, wellness and nutrition products
• The Rise of Pseudomedicine for Dementia and Brain Health published in JAMA (2019)
• Watch Out for False Promises About So-Called Alzheimer’s Cures published by the US Food & Drug Administration (FDA)