Leslie M. Klevay

The standard cup of coffee made by me or my wife is twice as strong as the cup my mother used to make. The mix of chemicals that we enjoy in a hearty brew depends on the amount and type of coffee, the quality of the water, type of pot and the temperature and time of preparation. And this mix will change if the coffee is prepared and kept warm for later consumption. The many variations on this theme illustrate some of the problems of self medication with botanicals such as ginger, ginko biloba or valerian, or with hormones such as DHEA (dehydroepiandrosterone) or melatonin. The number and type of dietary supplements available commercially has mushroomed during the last decade. Some of these materials are subjects of current, scientific research; others are in use as folk remedies, mainly in other countries.

The United States Pharmacopeial Convention (USP) was established more than 175 years ago when many medicines were obtained from the garden. Some physicians realized that the medicinal effects of extracts of plants, such as purple foxglove, prepared in a manner similar to the coffee mentioned above were too variable. Differences in plant variety, garden soil, climate, method of preparation and other factors produced a medicine that was far from uniform. The organization was founded to provide recipes and standards that would result in more uniform medicines having more predictable effects. Doses came to be defined better.

Penicillin may be a useful example to contrast the old and the new. Obtained from a mold by the Department of Agriculture during World War II, all of its descendants are single chemicals made by the pharmaceutical industry. The vast majority of prescription drugs and many over-the-counter medicines are based on single chemicals; most of these satisfy standards defined by the USP. This provides the best control of dose, effect and purity. For the most part, you know what you’re getting.

Dietary supplements are not subject to the same standards of dose, efficacy, labelling, purity and safety required for medicines by the Food and Drug Administration. To nutritionists supplements are essential nutrients such as vitamins or minerals like copper or iron. To dictionaries supplements are additions that supply a want.

Ginger and valerian are not approved as drugs in the U.S., but are used in Europe and Australia for nausea and insomnia, respectively. These materials are derived from roots, and each contains at least 50 distinct chemicals. Neither the active ingredients nor how they relieve nausea or insomnia are known. Melatonin and DHEA are pure chemicals with numerous biological effects, but neither a clear reason for use nor dose is well-defined. And neither hormone has been evaluated systematically for undesirable side effects. To some degree, a return to botanical remedies is a return to an earlier tradition. None of these materials is considered to be supplements by nutritionists.

Where does this leave the average person who may not wish to study pharmacology? Adventerous people who want to experiment should realize the possible hazzards. Cautious people may wish to abstain. Overall, let the buyer beware.