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.