The pill drill: How to choose supplements

You’ve got a cold. But you don’t want to gulp down more NyQuil. Or pop some Sudafed -- again. Should you take astragalus? Or garlic? Echinacea, goldenseal or zinc? Standing in the drugstore you realize you don’t know which brand to buy, or whether it even makes a difference.

You probably won’t get much help. Despite the fact that one in five Americans uses “natural” products such as herbs and enzymes, most Western doctors know little about them. Drugstore clerks aren’t generally trained in botanicals or supplements either.

And supplements come with few guarantees. Herbs are regulated as foods, rather than conventional drugs, meaning that the health claims on the bottles are vague and untested, adverse events are reported only after the fact, and what it says on the label isn’t necessarily what’s in the bottle. Clinical trials -- when they exist -- are typically conducted on one preparation, making it hard to extrapolate to other brands.

At a recent conference on natural supplements, we met Mark Blumenthal, executive director of the American Botanical Council, a nonprofit research and education organization funded in part by the herbal industry. The self-dubbed “herb cowboy,” dressed in his trademark Hawaiian shirt, was there to coach doctors and healthcare providers on how to select quality supplements. Afterward, we asked him if he had any advice for consumers.

Does it matter which brand of supplement you buy?

Yes, it makes a huge difference. Some herbal supplements are simply higher quality. Some have been shown to be effective and have clinical trials to back that up. Others do not.

Let’s say a consumer wants to do some research on a certain herb or supplement. Where can they go? What should they look for?

Self-medication requires self-education. If you want to start using herbs and other supplements for your health, it behooves you to learn as much as you can about that ingredient and company and to what extent it has been tested -- or not. The more research you do before you make a purchase, the better.

The best place to go is the Internet. Unfortunately there is no definitive database that includes all research and brand names. But there are some sites that can help. There is www.ConsumerLab.com. The American Botanical Council has HerbClip, a database at www.herbalgram.org. You can type in the name of a company or product, and see whether it has been tested or reviewed. There are more than 3,000 articles there.

There is also the Natural Medicines Comprehensive Database (www.naturaldatabase.com). It costs $92 a year and you can type in, say, garlic, and see which products have been clinically tested, and what drug-herb interactions there are.

Let’s say you didn’t do your homework and now you are standing in the store, trying to pick which supplement to buy. What should a consumer look for?

There are two basic criteria. One is quality, the other is efficacy. On the quality side you can look for one of the three to four different seals that various third-party verification organizations use. These include www.ConsumerLab.com; the National Nutritional Foods Assn. TruLabel program, www.nnfa.org; NSF International certification program, www.nsf.org; and the United States Pharmacopeia Dietary Supplement Verification Program, www.usp.org.

These are not seals of approval per se, but it means that the manufacturing facility has been inspected and meets certain standards of cleanliness, ingredient identity and quality control. In some cases, the seals mean a product has been tested by an independent laboratory. You have to go to the websites to know exactly what they mean.

You also want to make sure your herbal supplement is safe. Many of the herbal products that are sold in Europe as nonprescription medications are monitored for their safety through the same kinds of adverse reporting systems as our conventional drugs. Products that come from Europe, and many of the herbs made here with European preparations, have an excellent track record in terms of safety. Bottles will say something like “original German formula” on the package. Those brands are probably a good bet.

As for efficacy, if companies have conducted clinical trials on their own products they usually tell you right on the label or their website. That would be a very good way to determine whether or not a product would merit consideration.

Of course, there are exceptions to these rules. There are excellent quality products that do not have seals, and do not have information about clinical testing on their labels.

But if you follow these guidelines you will be on the right track.

Do you have any other advice for someone wanting to try herbal supplements?

The reason people are so interested in herbal medicines is because most of them are very gentle, and many of them work. But you have to use herbal supplements just as you would an over-the-counter medication: Follow directions.