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slimming teas that combine dozens of herbs, capsules that offer cures for various diseases and lotions to treat different parts of the body, the promises of herbal products irregularities are diverse. However, there is no proven effectiveness in using these treatments.
The most serious thing is that the excessive use of some substances, sold as “natural”, can cause serious health problems.
Despite this, many irregular products, that is, without registration in the National Health Surveillance Agency (Anvisa), are still freely available on the internet or in stores throughout Brazil.
In view of this scenario, Anvisa published, at the end of 2022, a booklet with guidelines on the safe use of herbal medicines e medicinal plants. The document teaches the population to check the registration of products with the agency and also to identify misleading advertisements and how to denounce irregularities.
What are herbal products?
Herbal Medicines are medicines obtained from medicinal plants and can only be produced by pharmaceutical industries or manipulated in pharmacies authorized by the Sanitary Surveillance. All industrialized herbal medicine must be authorized by Anvisa before being commercialized.
Once the agency verifies its composition, its quality and its therapeutic effects, that is, if it is effective for the proposed treatment. On the other hand, compounded herbal medicines are prescribed by health professionals and produced in accredited pharmacies.
However, many of the products sold on the internet or in health food stores do not fit this official definition, that is, they are not regulated.
“The first thing the patient must do is differentiate, that is, check whether he is actually using a herbal medicine regulated by Anvisa, or a fake product”, explains the doctor. Aecio Flavio Meireles Souzadirector at the Brazilian Society of Hepatology (SBH).
“In the case of irregular products, there are several risks, ranging from contamination of ingredients to the presence of anabolic substances hidden in products sold as natural”, explains the doctor.
Despite the risks posed by illegal products, the benefits of formulations made from medicinal plants and regulated by Anvisa are also great, as explained by the specialist in integrative medicine at Hospital Israelita Albert Einstein, Silvia Kawakami Pantaleao.
Risks and benefits
“Many herbal medicines bring benefits and have been used for a long time, in various applications. What is important is to remember that just because a product is natural does not mean it cannot be harmful. This is an illusion, but there are still many people who think like that”, says the doctor who is also coordinator of the neonatology sector at Hospital Municipal Dr. Moses Deutsch (M’Boi Mirim).
Dangers of irregular products
One of the organs of the human body most affected by the consumption of irregular herbal medicines is the liver, as it metabolizes several elements found in these formulas. The excess of so-called hepatotoxic substances (liver toxicity) can cause damage to the organ and even lead to fulminant hepatitis.
Many of the irregular compounds list herbs that pose a risk to the liver when used in high dosages. There is documented toxicity for ingredients such as green tea, horsetail, melissa, senna, centella asiatica, spirulina, and garcinia, which are commonly found in many of these products.
The risk is even greater when the products combine several ingredients at the same time, as explained by hepatologist Souza. In addition, encapsulated products, such as teas and herbal mixtures in capsules, are more dangerous because they have a higher concentration of toxic active ingredients.
“Teas and capsules that mix many herbs are even more risky because there can be a number of interactions between them. In addition, you can have a combination of several substances that are harmful to the liver at the same time, in a single product”, explains the specialist.
According to the hepatologist, cases of fulminant hepatitis caused by products considered natural are usually more serious than those caused by excessive consumption of medicines.
This is because irregular natural products bring an unknown combination of toxic substances. Thus, it is more difficult to establish a cause and effect relationship between the ingestion of substances and the liver problem.
“The big difference is that when you have drug intoxication, we already know the effects of each formulation. Now, when it is by herbal medicines, herbs or teas, fulminant hepatitis evolves much more quickly and seriously. We can’t always pinpoint exactly what caused it. The incidence of liver transplants, in these cases, is higher”, says the director of SBH.
A case that became emblematic was that of the nurse Mara Abreu, who died in March 2022 at age 42 after complications from a liver transplant. Mara underwent a transplant after suffering from fulminating hepatitis caused by the consumption of a slimming tea in capsules that mixed 50 different herbs.
In addition to bringing health risks, many of these substances have no proven efficacy in the treatments they promise. Slimming teas, for example, are contraindicated by endocrinologists because they combine herbs and medicinal plants that do not help with weight loss.
Experts explain the effects of herbal medicines
According to experts, no tea is capable of promoting weight loss. In fact, what some do is increase urine production, which can lead to dehydration and a false sense of weight loss.
In addition to liver risks, irregular herbal products can also compromise the functioning of other medications. This is the case with those containing activated charcoal, a substance that became famous after celebrities, such as the American Kim Kardashian, publicized its supposed slimming effects.
Charcoal is used in medicine to treat cases of drug or food poisoning, as it tends to absorb toxins present in the digestive system. However, this ability to absorb substances can also be harmful to health, as explained by the doctor. Pantaleondo Albert Einstein.
“Activated charcoal has a lot of interaction with other medications. One of its most common effects is to cause constipation, but it also has the power to absorb substances, which can even cut the effect of continuous-use medications”, warns Pantaleão.
“He is not slimming. What it does is absorb various substances, and this can disrupt the absorption of important substances for the body, such as vitamins and minerals,” adds the hepatologist.
To avoid complications related to the use of irregular products, it is important to always check if a herbal product has an active registration or notification with Anvisa.
There are registered herbal medicines, which go through the agency’s complete evaluation procedure, and notified herbal medicines, which, as they are considered to be of lower risk, undergo a simplified evaluation.
Registered herbal medicines bear the registration number on the packaging. The notified herbal medicines, on the other hand, do not have a registration number, but a phrase that indicates that it has been notified. To verify that the registration is not falsified, it is necessary to consult the name of the herbal medicine, whether registered or notified, on the Anvisa website.
The need for registration applies to any product that makes therapeutic claims, that is, any item that promises to bring health benefits. In addition, by law, these products can only be sold in pharmacies and drugstores, regardless of their category.
According to Anvisa, these registration requests have the highest rate of denials of registration requests in the agency’s drug area: about 43% of requests sent for registration of herbal medicines are denied, against about 23% for generic and similar drugs, and just over 13% for new drugs.
To obtain registration, herbalists need to follow certain rules. The use of terms such as “max”, “super” and “extra strong” and images of body parts is prohibited. Experts advise consumers to be wary of tea products that show ripped abdomens on the label.
Another Anvisa requirement is that the product list the botanical name of the medicinal plant used. This name is made up of two words written in italics — for example, the scientific botanical name of boldo, often used in teas, is We are brave.
Another indication that the product is irregular is the presence of many herbs mixed in the same formulation. According to Anvisa, there are currently no regularized products containing large amounts of medicinal plants.
Following these criteria, the chance of finding a herbal product that actually brings real benefits to health is much greater. Still, many doctors recommend that their patients consult specialists before starting to use herbal products.
“The doctor who is at the front end, who is at the health center, does not always know what the patient is taking. It is always important to communicate and consult the doctor, because the medicinal plant also has to be in the right dosage. It’s like the difference between medicine and poison”, assesses doctor Pantaleão.
“The herbal medicines are great as options for the population. It is no wonder that around 40% of the medicines we have were created from medicinal plants”, explains Souza.
“The big risk is not in the herbal tea sold in the pharmacy, but in that tea that you buy by weight, without a label, which promises to work miracles, but which can even be contaminated by fungi. This is where we need to be attentive”, adds the SBH director.
Technical review: Alexandre R. Marra, researcher at the Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEP) and permanent professor at the Graduate Program in Health Sciences at the Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE).