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Pappas gets advice from Lisa Cosman, 60, a self-described nutritionist with no formal training or certification (only 23 states require licensing of dietitians and nutritionists) who relies on news accounts to keep abreast of new research. Cosman warns her clients to visit a doctor before taking herbs and fears that too many are searching for magic bullets. "My concern is that they are overhyping herbs," she says, "and missing the central idea that you must eat healthy."
In Chicago, marathoner Tom Smithburg works out daily and, in place of morning coffee, downs a megadose of ginseng: 1,000 mg, vs. the recommended maximum of 600 mg. "Coffee is a drug," says Smithburg, a public relations representative of the Chicago Bulls. "I hear more people complaining that they have headaches over the weekend from not getting their caffeine."
That herbal preparations seem--and are marketed as--"natural," as distinct from synthetic pharmaceutical drugs, adds to their appeal. "A lot of people feel comforted by taking something they regard as a natural substance," says Dr. Sidney Bogardus, who directs Yale's Geriatric Assessment Clinic. "Of course, the substances in an herb are chemicals just as they are in medicine made by pharmaceutical companies. But it seems more gentle and safe, and people are reassured by that."
Some unwary consumers, though, have been getting hurt. Geoffrey Bove, a pain researcher at Boston's Beth Israel Deaconess hospital, recalls a woman whose skin became hypersensitive when she stepped into sunlight. Even a mild breeze triggered a painful reaction. Bove traced the cause to the St. John's wort that the woman was taking to combat mild depression. When she switched to a prescription drug, the painful burning vanished.
The woman's distress points up the danger of taking herbs without considering the side effects or gauging other risks. Yet many physicians have received little training in nutrition or herbal medicine. In Los Angeles, neuropsychiatrist Dr. Ronald Lawrence runs the Council on Natural Nutrition and teaches at UCLA, where he is deluged by questions from doctors seeking information about herbs. "I can't keep up with the phone calls," he says.
With consumer interest rapidly spreading, the medical profession is gradually and sometimes grudgingly learning the benefits and pitfalls of nutritional supplements. More than 50% of U.S. medical schools now offer courses in unconventional medicine such as homeopathy (a system that uses highly diluted remedies) and acupuncture. Says Dr. Woodson Merrell, who has taught nutrition and herbal medicine to practicing physicians at Columbia University: "The point is that this is not alternative but complementary medicine."
Which herbs work, and which ones don't? Recent scientific research--and fresh attention to practical evidence that sometimes stretches back millenniums--is beginning to give guidance. In Germany, where the government has supervised studies of 279 herbs approved for sale in the country's strictly regulated pharmacies, remedies that enjoy the greatest popularity (including ginkgo, kava and St. John's wort) are generally those that have been the most thoroughly investigated.