http://www.nando.net) --

Burkhard Bilger and his wife never heard that the ancients used the herb
pennyroyal to induce abortion. They just liked the tangy mint taste of
pennyroyal tea -- until she discovered she was two months pregnant, and her
doctor asked her to avoid caffeine.

Soon after, Jennifer Bilger had a miscarriage.
When he learned the tea may have been to blame, "I was horrified," said
Bilger, a New York science editor who contends supplements don't come with
proper warnings. "There are a lot of very potent herbs out there. You go into
a food co-op, and you don't know what you're getting."

An Associated Press analysis of Food and Drug Administration records suggests
Bilger's experience is not uncommon: The agency has logged more than 2,500
reports of side effects and 79 deaths associated with dietary supplements.

About 900 of the illnesses and 44 deaths involved people taking herbal
products that contain ephedrine-like stimulants. Other possible culprits range
from "diet teas" to hormones like DHEA and even high-dose vitamins.

Millions of Americans take dietary supplements, particularly the herbs that
are the fastest-growing segment. They spent $3.2 billion last year.

Supplements promise they'll slow aging, improve memory, clean kidneys, protect
the heart, even prevent cancer.
There is evidence that certain herbs, vitamins and minerals do help. Folic
acid prevents birth defects. Calcium wards off osteoporosis. Many scientists
agree that garlic may help lower cholesterol, ginger calms nausea, and
valerian is a mild sleep aid. The National Institutes of Health is studying
whether St. John's wort is an anti-depressant.

But scores of other products have sparse, if any, data to support claims that
even some in the industry call exaggerated. The pills, tonics and teas sell
with little to guide consumers about what actually works or potential side
effects.

"You almost have to be a detective," said Mary Ellen Camire, food sciences
chief at the University of Maine, who studies natural remedies.

Most such products do not raise safety concerns, said Elizabeth Yetley, FDA's
chief of special nutritionals, but the agency has listed 16 supplements as
risky.
"You're self-medicating," notes Mark Blumenthal of the nonprofit American
Botanical Council. "People should learn how to use these products properly."

The boom in dietary supplements dates to 1994, when Congress shielded them
from most government oversight. They sell without prior certification or
purity inspections.

The 1994 law prohibited supplements from advertising that they directly treat
or prevent disease but allowed more vague claims of "supporting bodily
functions." The FDA is supposed to intercede only if it proves a supplement
poses an unreasonable risk or is marketed as a drug.

The result is a gray area where Vitamin A, for example, can advertise as
"essential for healthy vision" but not to treat eye diseases. Willow bark
contains the same chemical as aspirin but doesn't have to carry aspirin's
warning: "Do not give to children or teen-agers with flu or chickenpox because
they could develop deadly Reye's syndrome."

A presidential commission called last fall for changes to clear the confusion.
It urged the FDA to review herbal supplements and let those that clearly work
sell as over-the-counter drugs -- clearly labeled with proved benefits and
side effects.
The panel also urged that industry provide studies backing a product's claims
if consumers request proof, that the FDA act swiftly against risky
supplements, and that makers adopt proper warnings.

Some in industry already are acting. A new American Herbal Products
Association handbook classifies the risks of 700 herbs with suggested warning
labels for its 200 member companies.
And the botanical council this spring will publish a long-awaited translation
of Germany's "Commission E" safety and effectiveness evaluations of 300 herbal
products, 200 of which were approved as drugs in that country. The document is
considered the world's best guide.

"There is a sensitivity in the industry about all the concerns that exist and
the need to provide as much information as possible," said Annette Dickinson
of the Council for Responsible Nutrition.
She said the FDA has not acted appropriately against exaggerated claims or, in
the ephedra case, risky supplements.
The FDA's first response to the presidential commission may come by Tuesday.
Officials say they haven't decided whether some supplements can become
nonprescription drugs as recommended.

Instead, they first will better define just what claims supplements can make
-- that "maintaining healthy cholesterol" could be OK, while "lowering blood
pressure" would not be.
Regulations aside, experts warn that "natural" doesn't necessarily mean
"safe."

Take ephedra. Chinese herbalists made teas from these plants to open clogged
airways. But those teas contained just 1 percent ephedrine alkaloids, or
stimulants, while modern supplements contain up to 9 percent, Camire said.
Pushed as weight-loss or bodybuilding pills, they are taken today for far
longer periods, and some are concentrated into herbal variations of the
illegal drug speed.

Faced with reports of 44 deaths -- including heart attacks in healthy college
students -- the FDA proposed slashing ephedrine dosages in supplements and
banning their sale for weight loss or bodybuilding.

Yetley acknowledges the FDA lacks a good safety net to catch risks. Consumers
and doctors can report suspected side effects, but the information is often
too sketchy to pinpoint blame.
To help, the American Association of Poison Control Centers is beginning a
study to track supplement poisonings.