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Makers call them drugs, doctors say they are threats to health (2)

Assorted herbal mixtures
| credits: Solaade Ayo-Aderele

Users of herbal mixtures swear by them; but physicians, chemists and laboratory technologists say the ingredient combination is cause for concern. In this conclusion of the two-part series, SOLAADE AYO-ADERELE talks to experts in both herbal and orthodox medicines

At the Lagos-Ghana Motor Park on Old Abeokuta Motor Road, Agege, Lagos, brisk business was going on in one wing of the park. As some women dished out food to customers, some people were attending to customers who had come to consult with them in one area of health or the other.

These are not licensed medical practitioners but men and women who claim to have deep knowledge of herbs and how to use them to cure any ailment whatsoever.

One of their customers who agreed to speak with this reporter confesses that the herbal mixtures do work.

Aged 42, the mother of one says she suddenly stopped seeing her menstrual period sometime last year, and the condition lasted for three months.

She says she is a university graduate who holds a good job. So, she did not patronise the herbal mixture merchants for lack of money to attend regular hospital, but because she has been told that the herbs are very effective in tackling her symptoms.

She consulted with the herbal dealers and confesses that she was satisfied with the outcome.

Asked how she got to know them, the woman who refused to give her name says she was referred by her hair dresser.

She intimates that when she described her symptoms to one of the herbal dealers — a woman — she was given Asheitu, an unnamed tablet and a smaller bottle of herbal preparation. She says she was taught how to mix them. She followed the prescription and in less than three days afterwards, she started bleeding.

She says she has since continued to have her period as at when due.

Another user of Asheitu, a young lady in her 20s, says she uses the herbal mixture as a laxative. Though they both confess to the effectiveness of this particular herbal preparation, the only complaint they have is that it is too bitter.

Minister of State for Health, Dr. Khaliru Alhassan

The mother of one however says she only used the preparation briefly and that once her condition improved, she has not had any reason to use it again.

The herb merchants refused to volunteer any information about themselves or their trade.

In like manner, none of the manufacturers of the herbal products under review was willing to talk. When a call was placed to one of the numbers listed on Dr. Iguedo’s Goko Cleanser Herbal Mixture, the male who picked it up said he was in a meeting and asked this reporter to send a text message.

We did, asking him to confirm the veracity of the claims listed on the pack, but up till 7:19pm of Tuesday when the production was being wrapped up, he had yet to respond.

Other numbers were either “switched off” or “out of service provider’s coverage.”

Despite the glowing testimonies that herbal mixture users give about the products, researchers say the active ingredients call for concern, simply because inappropriate handling could be dangerous for users.

Eugenol: An ingredient like no other

Eugenol is one of the active ingredients in virtually all the herbal mixtures under review. Using Gas Chromatograph Mass Spectroscopy, researchers at the University of Lagos, under the supervision of Mr. Mejida Sumaila, investigated the chemical composition of the essential ingredients in the herbal mixture samples. Many of these active ingredients are not listed on some of the mixtures as presented to buyers.

Mejida notes that the leaves seem to absorb the alcohol inherent in the herbal mixtures, making the alcohol less pronounced in the samples submitted for analyses. “That is not to say that the alcohol in the herbal mixtures is of lesser effect,” Mejida warns.

Chemists say eugenol is one of the chemicals in clove — an herb whose oils, dried flower buds, leaves, and stems are used to make medicine.

In natural medicine, clove oil and one of the chemicals it contains (eugenol) are used in combination with other ingredients for specific ailments. When used as a cure for premature ejaculation, scientists say, the mixture should not be administered orally. Rather, it should be “applied to the skin of the penis” as part of a multi-ingredient product.

Even in its use to curb premature ejaculation, researchers warn that it should only be “applied to the glans penis an hour before intercourse and washed off immediately before intercourse!”

“Clove seems likely safe for most people when taken by mouth in food amounts, but not enough is known about the safety of taking clove by mouth in larger medicinal amounts,” they warn.

Indeed, they warn that eugenol seems to slow blood clotting; and there is a concern that it might cause bleeding during or after surgery!

There are also concerns that eugenol may cause bleeding in people with bleeding disorders. Worse, physicians say, when a preparation that contains eugenol is used alongside medications that slow blood clotting such as aspirin which also relieves pain, the result is better imagined.

The same result happens when eugenol is combined with herbs such as garlic, ginger, ginkgo, red clover, turmeric and willow, which are known to slow blood clotting.

“This is one of the reasons people drop dead unceremoniously and their survivors readily attribute such deaths to witchcraft, because it is sudden and they probably didn’t expect it,” Family Doctor, Dr. Greg Akinduyile, says.

Leaf combination makes for effectiveness

Epidemiologist and Chief Consultant, Holistic Lifecare Centre, Prof. Dayo Oyekole, says it is wrong to isolate herbal ingredients and conclude that they are dangerous. He says when herbs are combined in appropriate measures, they act in synergy to meet users’ needs.

Oyekole

“Active ingredients don’t exist in herbal medicines the way they do in orthodox medicine. This is because herbs don’t act directly as singular entities; rather, they work together in synergy. That way, they are able to meet the needs of the user, with minimum side effects” Oyekole says.

Oyekole, who holds a PhD in epidemiology from the University of Ibadan, says there is no plant that does not have negative effects. “Those negative effects are countered and made safe when specific herbal plants are combined as appropriate, making them safe for human use. And that is what we refer to as the natural balancing power of herbs,” he intones.

On the use of alcohol in herbal mixtures, Oyekole warns that it could have lethal effects on the liver and the kidneys.

He also expresses concerns about the proliferation of aphrodisiacs which are presented to users as herbal preparations. He condemns the unusually high alcohol contents of some herbal mixtures, saying they are inimical to users’ health.

“Users of such products not only risk liver cirrhosis, the products could also predispose them to prostate cancer,” the epidemiologist cautions.

Killing your baby softly

As for children who are exposed to herbal mixtures containing eugenol, researchers say they risk severe side effects such as seizures, liver damage, and fluid imbalances.

In general, physicians say overexposure to this singular ingredient can cause shallow or rapid breathing, coughing up blood, blood in the urine, no urine output or pain while urinating.

It could also cause burns in the mouth and throat, while it may also lead to abdominal pain, diarrhoea, liver failure (especially in children), nausea and vomiting.

It may also lead to rapid heartbeat, coma, dizziness, seizures and unconsciousness.

When asked if the herbal mixtures that specify paediatric application are safe for children of ages two years upwards, Head, Medical Services, College Medical Centre, Federal College of Education (Technical) Akoka, Lagos, Dr. Rotimi Adesanya, couldn’t believe that a mere 100ml bottle of herbal mixture could have as much as 40 or 42 per cent alcohol volume.

To be sure, he asks, “Is it four per cent alcohol content or 40 per cent? If it’s the latter, then 40 per cent is quite much. Kindly confirm, because even beer has only six per cent alcohol!”

Adesanya expresses no doubt that the alcoholic drugs may have some effects on children users. “Some may have drowsy effect, and some children may get addicted. It will definitely affect their cognition on the long term,” Adesanya warns.

He also warns that such herbal mixtures are not advisable for lactating mothers to take, as some of the alcohol may be passed on to the child through the breast milk.

He suggests that the National Agency for Food and Drug Administration and Control, as the regulatory body, should certify such medications safe for human consumption before they are allowed to be sold to people.

He says, “As a physician, I don’t recommend or prescribe herbal mixtures because most manufacturers don’t do the requisite rigorous clinical trials before products are launched into the market. With orthodox medicine, that is absolutely impossible. And that’s why even medicines that pass through the needle’s eye before certification can also be withdrawn if there is evidence that users are experiencing extreme side effects.”

He says that as a paediatrician, he had had to treat a baby that kept vomiting uncontrollably after the parents had used herbal medications for him. “It nearly killed the baby,” Adesanya deposes.

Kidney ailment, liver failure catalyst

“There’s no denying the link between alcohol consumption and kidney disease,” Public Health Specialist and Paediatrician, Dr. Rotimi Adesanya says. He laments that in recent times, Nigeria has recorded more cases of chronic kidney diseases and liver failure, both of which have, through clinical analyses, been linked to indiscriminate consumption of high volumes of alcoholic beverages or mixtures among those who presented for treatment.

According to a 2013 statistics on kidney disease in Nigeria, 36.8 million Nigerians — or 23 per cent of the population — are suffering from various stages of kidney disease!

President of the Nigeria Association of Nephrology and Chief Medical Director of St. Nicholas Hospital, Lagos, Dr. Ebun Bamgboye, disclosed this during the World Kidney Day. “With this figure, it means that one in seven Nigerians is suffering from some form of kidney disorder,” the physician notes.

He also says that an estimated 15,000 new cases are diagnosed annually in the country, with no hope of decline in the figure as at present.

Dr. Ifeoma Ulasi of the Renal Unit, Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, says end-stage renal disease accounts for eight per cent of all medical admissions and 42 per cent of renal admissions in the country.

Kidney ailment is not limited to adult population alone; and, based on the fact that these herbal mixtures are also used for children as young as age two without physician’s supervision, it is just normal to expect as bad a result among child users.

Paediatric Nephrologist, Dr. Odutola Odetunde of the Department of Paediatrics, University of Nigeria, Enugu Campus, notes that over a five-year period between July 2007 and June 2012, the University of Nigeria Teaching Hospital, Enugu, recorded 3,002 paediatric admissions, out of which 98 — or 3.3 per cent — had Chronic Kidney Disease, giving incidence of 3.0 new cases per million-child population per year and the prevalence of 14.9 per million children population.

He adds, “The most common features were suggestive that both kidneys were affected.

“Eight of them died while on admission, 15 left against medical advice mainly because of financial constraints, 25 were discharged on conservative management and lost to follow-up, while another 50 were discharged and currently on follow-up.”

He discloses further that, “At presentation, nine of the children were below five years of age, 36 were aged between five and 10 years, while 53 were between 10 and 16 years.”

While physicians agree that kidney diseases among children could be as a result of many factors, they are not ruling out possible link with unorthodox use of herbal mixtures whose active ingredients may be too potent for otherwise tender organs of a minor.

Adesanya wonders, “What kind of mother would use herbal preparation with 40 percent alcohol volume for a two-year-old and expect good outcome?”

Having seen a baby who suffered alcohol poisoning when the parents used one of these herbal mixtures for him, the physician says, “I can safely conclude that orthodox physicians are right in not identifying with these suspicious mixtures.”

Drugs or aphrodisiacs?

Oremiti Herbal Energiser is indicated for sexual prowess. But although most of these herbal mixtures are touted as capable of giving men high sexual power, Professor of Reproductive Endocrinology, Oladapo Ashiru, warns that in men, alcohol can make getting and maintaining an erection difficult.

He says, “Alcohol is both a stimulant and a relaxant to the brain, depending on the time interval after use. In fact, it reduces sexual sensitivity, especially among regular and prolonged users.”

He adds, “In men, alcohol can cause difficulties getting and maintaining an erection, while women may experience reduced lubrication, find it harder to have an orgasm, or have orgasms that are less intense.”

Scientists say many people mistakenly believe that alcohol is an aphrodisiac. They say over time, too much alcohol can actually put a dampener on your sex drive.

“Drinking too much over an extended period of time can turn a temporary condition like ‘Brewer’s Droop’ into full-blown impotence,” scientists warn.

Ashiru adds that drinking can also cause damage for couples planning to have children. “Women who imbibe can take longer to become pregnant and they can also suffer from menstrual and fertility problems,” he cautions.

Drug interactions

Experts at the online portal, drugs.com, say though herbal supplements may be from plant or herb sources, the active ingredients can still be potent chemicals. “Because of this, herbal supplements can have drug interactions, even with each other or with food or alcohol,” they enthuse.

They, however, lament that since the products are not labelled with safety warnings, it is difficult for consumers to know if an interaction may occur.

“Herbal interactions with prescriptions can interfere with how the drug may be broken down in the body, enhance side effects of prescription medications, or block the intended therapeutic effect of a drug,” the scientists warn.

Cure-all herbal preparations

One thing that is rather peculiar to virtually all the herbal medicines is the claim that they cure almost any disease under the sun.

The same herbal mixture that takes care of menstrual irregularities is also indicated for migraine, worm expeller, urinary incontinence, pile, premature ejaculation… You name it!

Oyekole the epidemiologist says it is possible for a combination of herbs to cure multiple conditions, depending on the condition being treated and the herbs involved. He says if a person who is knowledgeable in the use of herbs combines them in appropriate measures, there should be no cause for worry.

Experts say, for instance, cinnamon can be used to lower blood sugar among the diabetic, while the same herb can also be indicated in the treatment of high cholesterol and triglycerides without the fear of injuring heart health.

The physicians we talked to however say that herbal mixture manufacturers should be more open with their ingredients so that the regulatory agencies can rightly place them where they belong.

Oyekole laments that the majority of people who manufacture the so-called herbal mixtures have made so much money with which they bribe the regulatory authorities, saying that is why they roll out products with questionable integrity.

He asks, “Why would any preparation have 40 per cent alcohol in 100ml content? That couldn’t be right under any circumstance.”

Oyekole appeals to NAFDAC to go beyond mere listing of herbal products to seeking enabling law that will compel the manufacturers to submit their products for rigorous clinical analysis and testing on animals and humans before they could be sold as drugs.

“Anything short of this is unacceptable,” Oyekole says.