32
2003–2006 reported that 20% of adults use a supplement containing at least one
botanical ingredient (Bailey et al. 2010). A common motivation for taking these
substances is to “improve overall health”. Accordingly, the FDA regulates the
majority of botanicals as dietary supplements and not as drugs developed for the
treatment or prevention of specific maladies (FDA 2016). Botanical use is correlated with non-smoking and higher self-reported health (Bailey et al. 2013).
Alarmingly, patients frequently do not report herbal supplement use to primary care
physicians (Wu et al. 2011), a concern because many botanical supplements may
interact with prescribed medications. On their own, bioactive constituents of botanicals can have acute adverse effects that require hospitalization. This review describes
acute adverse effects and herb-drug interactions of the most common botanical and
herbal supplements. As a result of their plant-based derivation, botanical supplements consist of a mixture of organic compounds. Only a fraction of these compounds is biologically active, with a small subset of the active compounds having
therapeutic and/or toxic mechanisms of action. Table 3.2 presents a list of commonly used and researched botanical supplements, their primary active constituents
and typical use. Concurrent exposure to other compounds (e.g., pharmaceuticals,
smoking) and the heterogeneity of herbal supplements often obfuscates the determination of toxic mechanisms in clinical cases, even when doses of the supplement are
reported. As such, reports of adverse effects directly attributable to botanicals are
generally rare (Di Lorenzo et al. 2015). In most such cases, effects are mild (e.g.,
nausea, fatigue, and headache). However, more serious clinical cases have appeared,
most often relating to adverse effects falling under the general category of druginduced liver injury and its associated mechanisms, namely mitochondrial dysfunction, oxidative stress, and alteration of bile acid homeostasis.
3.8 Advantages and Limitations
The advantages that nutritional supplements generally offer includes high content
of nutrients in small volumes; special nutrient compositions; lack of undesirable
accompanying substances such as fats, cholesterol and purines; and complete coverage of specialized sporting needs. Nevertheless, these formulations should be
treated as a supplement of basic healthy diet and not as a replacement. Users of
dietary supplements often increase the dosage or frequency. As a result, doses
become less and less effective. Thus, the human organism is forced to work harder
to eliminate the extra amounts of supplements taken in (Thomas 2001). All these
factors lead to the appearance of side effects due to toxicity of dietary supplements,
which depends on the factors including (a) The dosage, because exceeding the recommended dosage may cause side effects; (b) The duration of intake which is
related to the fact that the human organism is overloaded, owing to specific substances that the supplement contains, till the substance is eliminated; (c) The special
chemical properties of some substances and their interactions with other foods and
substances; (d) The person’s weight who takes those supplements; (e) Age, because
S. Hassan et al.
2003–2006 reported that 20% of adults use a supplement containing at least one
botanical ingredient (Bailey et al. 2010). A common motivation for taking these
substances is to “improve overall health”. Accordingly, the FDA regulates the
majority of botanicals as dietary supplements and not as drugs developed for the
treatment or prevention of specific maladies (FDA 2016). Botanical use is correlated with non-smoking and higher self-reported health (Bailey et al. 2013).
Alarmingly, patients frequently do not report herbal supplement use to primary care
physicians (Wu et al. 2011), a concern because many botanical supplements may
interact with prescribed medications. On their own, bioactive constituents of botanicals can have acute adverse effects that require hospitalization. This review describes
acute adverse effects and herb-drug interactions of the most common botanical and
herbal supplements. As a result of their plant-based derivation, botanical supplements consist of a mixture of organic compounds. Only a fraction of these compounds is biologically active, with a small subset of the active compounds having
therapeutic and/or toxic mechanisms of action. Table 3.2 presents a list of commonly used and researched botanical supplements, their primary active constituents
and typical use. Concurrent exposure to other compounds (e.g., pharmaceuticals,
smoking) and the heterogeneity of herbal supplements often obfuscates the determination of toxic mechanisms in clinical cases, even when doses of the supplement are
reported. As such, reports of adverse effects directly attributable to botanicals are
generally rare (Di Lorenzo et al. 2015). In most such cases, effects are mild (e.g.,
nausea, fatigue, and headache). However, more serious clinical cases have appeared,
most often relating to adverse effects falling under the general category of druginduced liver injury and its associated mechanisms, namely mitochondrial dysfunction, oxidative stress, and alteration of bile acid homeostasis.
3.8 Advantages and Limitations
The advantages that nutritional supplements generally offer includes high content
of nutrients in small volumes; special nutrient compositions; lack of undesirable
accompanying substances such as fats, cholesterol and purines; and complete coverage of specialized sporting needs. Nevertheless, these formulations should be
treated as a supplement of basic healthy diet and not as a replacement. Users of
dietary supplements often increase the dosage or frequency. As a result, doses
become less and less effective. Thus, the human organism is forced to work harder
to eliminate the extra amounts of supplements taken in (Thomas 2001). All these
factors lead to the appearance of side effects due to toxicity of dietary supplements,
which depends on the factors including (a) The dosage, because exceeding the recommended dosage may cause side effects; (b) The duration of intake which is
related to the fact that the human organism is overloaded, owing to specific substances that the supplement contains, till the substance is eliminated; (c) The special
chemical properties of some substances and their interactions with other foods and
substances; (d) The person’s weight who takes those supplements; (e) Age, because
S. Hassan et al.