Caution needed in using dietary aids

Caution needed in using dietary aids

By I. Christianto and Bruce Emond

JAKARTA (JP): In their bid for better health, many people are
taking dietary aids and sports supplements commonly found in
stores and advertised on TV.

They may feel comforted by the "all-natural" claims of some of
the products, but doctors warn that several herbs must be used
with caution.

A U.S. study released last week said that some common herbal
remedies -- such as garlic, echinacea and ginseng -- might cause
serious complications, including internal bleeding and low blood
sugar, for patients undergoing operations.

It advised doctors to know a patient's complete history of
herbal medicines before booking them in for operations.

"John", who has taken echinacea to ward off cold sores and St.
John's Wort, touted as "nature's antidepressant", once
experienced an adverse reaction to another herbal supplement.

"I was staying at a friend's house and decided to try
valerian, which the label said was good for creating a feeling of
calmness," the 30-something expatriate said.

"Instead, I felt nauseous, woozy and I broke out in a cold
sweat."

One herbal medicine, a type of dry shrub called mahuang,
better known as the chemically synthesized ephedra, has been
attracting a lot of attention.

In its crystalline alkaloid form of ephedrine it has
traditionally been used for relief of hay fever, asthma and nasal
congestion. Now it is being used to aid in weight loss, and drugs
containing ephedra are easy to find in health supplement stores
in major cities across the country.

Some health experts contend that its prolonged use or overdose
appears linked to cases of heart attack, stroke, high blood
pressure and other dangerous side effects. Some women in the
United States have reported psychotic episodes after using
ephedra.

Others argue that the criticism of ephedra is unjustified and
that it can be used safely as long as it is carefully prescribed.

A shinshe (Chinese healer) and acupuncturist Djiauw Wie Yung,
who practices in Glodok, Jakarta's Chinatown, said that the
amounts of ephedrine alkaloids varied in different species of
mahuang.

Djiauw said the ancient Chinese used mahuang to relieve
symptoms of cold, influenza, asthma and allergies.

"Mahuang is actually only a small part of a mixed herbal
medicine," he said, adding that the recommended dose of the herb
was 10 milligrams in each medicine.

He acknowledged a common side effect of too much ephedrine was
hypertension, but believed that most of the reported health
problems were probably due to using the synthetic form.

Many Chinese drugstores in Glodok offer mahuang but there is
usually a shinshe on site to prescribe what they need.

Visitors meet with the shinshe, who decides what herbs and
roots are necessary to cure their condition and prepares a
prescription. The patient is not obliged to buy the medicine at
the drugstore but usually does.

However, people do not have to have a prescription from a
shinshe to buy the herb. One woman assistant at a Glodok
drugstore said people often came in to request mahuang or ephedra
but she did not ask them what they wanted it for.

Amphetamine

The chairman of the Foundation to Empower Indonesian Health
Consumers, Marius Widjajarta, said dietary pills usually contain
ephedrine as the substance can easily alter into amphetamine,
which increases energy while acting as an appetite suppressant.

"Ephedrine should be used very carefully as it has a negative
effect if there's no supervision by a physician. Although
ephedrine is not categorized as a psychotropic substance, its
basic structure formula easily changes into a psychotropic
substance."

He warned that in this form the substance could be addictive.

There is no regulation from the Food and Drug Control Agency
(BPOM) on the recommended dose for ephedrine in either Chinese
medicine or dietary aids and sport supplements.

BPOM's information center does not have any information
related to pharmaceutical products sold in Indonesia which
contain ephedrine.

Unfortunately, it may be yet another case of the country
lagging behind other nations in anticipating possible medicinal
hazards to its citizens. The government was faulted several
months ago for dragging its feet in deciding on the permitted
content of phenylpropanolamine (PPA), which has been linked to
stroke when taken in large doses in flu and cough medicines.

So far, instead of setting out to fulfill its mandate to
protect consumers, BPOM appears to take action only when there
are claims from other parties about drugs or foods which pose a
potential hazard to humans.