Herbs or poison?

Assorted herbal mixtures | credits: Solaade Ayo-Aderele

The Nigerian landscape is littered with assorted drugs and quasi-drug products, many purportedly licensed by the National Agency for Food Drug Administration and Control; many more being produced locally or imported and offered for sale without authorisation. SOLAADE AYO-ADERELE took some of these products for laboratory analysis and reports her findings

It was early morning at the Iyana Ipaja area of Lagos State and the seller of Dr. Iguedo’s Goko Cleanser Herbal Mixture was having brisk business. He was so persuasive in his advertisement of this mixture that the average person simply wanted to have a go at it.

And with the herbal mixture’s capacity to “eliminate worms, cure internal heat, rumble (sic) stomach, indigestion of food (sic), soften hard stool, reduce stomach sores (ulcer), prevent piles (sic) and purify blood,” it is easy for it to become a “drug” of choice for an unwary person.

Upon inquiry, the seller, a man who would not give his name, says the mixture also cures fibroids, eases menstrual pain and “regularises” a woman’s monthly period, such that if the period used to come on different days of the month, Goko Herbal Mixture would regularise it and the period would become predictable because it would now start coming on the same date every month — an enviable medical feat, you’d say; except that in real life, women’s menstrual flow can’t possibly happen on a fixed date.

The leaflet that comes with the mixture gives further instruction about its “indication.” In women, “It prevents fibroid and typhoid, improves fertility, prevents toilet diseases (sic), and reduces excessive fat and pot belly.”

For men, Goko Cleanser “Eliminates acute waist pain, enhances quick erection, improves sexual performance, boosts sperm count, prevents bacterial infections and typhoid, reduces excessive fat and pot belly, and it also reduces blood sugar level.”

The mixture, the leaflet adds, “Enhances youthfulness, removes harmful toxins from the body systems, prevents oedema and numbness, and also boosts the immune system.”

Adults are expected to take two tablespoonfuls thrice daily, while children ages six and above are advised to take one tablespoonful thrice daily.

Those suffering from bloody stools, cholera, diarrhoea and those in the first two trimesters of pregnancy are advised against using the mixture.

Buyer beware

And although the mixture comes with the National Agency for Food Drug Administration and Control Registration Number A7-0804L, a buyer-beware is attached: “These claims have not been evaluated by NAFDAC.”

When contacted, the Assistant Chief Public Relations Officer (Lagos Zone) for NAFDAC, Mrs. Christiana Obiazikwor, says in reality, what the herbal mixture makers actually parade on their products are the agency’s listing numbers that indicate that NAFDAC has tested them for safety in humans.

Obiazikwor says, “The number on any herbal product is mere listing, which shows that our agency has tested it for toxicity and passed it as being safe for use in humans. What we do is that when the herbal mixture manufacturers submit their products, we run standard tests on them to determine whether or not they are safe for human use.

“As for the claims about their therapeutic potency, we cannot guarantee that. This is because in order for us to support their claims that the mixtures truly cure the ailments they claim they do, the manufacturers must list the active ingredients on the bottles — as do orthodox medicine makers; and they must give us the liberty to run standard tests on them, after which they would be made to undergo clinical trials in animals and, later, in humans.

“If what they claim agrees with the results of our clinical tests, then NAFDAC will state so, effectively supporting their claim. But the problem with these herbal mixture makers is that, unlike their orthodox counterparts, they are always reluctant to state the active ingredients.

“Of course, herbal mixtures have been with us for ages and people use them, based solely on faith and the assurance by those who claim to have used them for particular ailments. But as an agency that relies solely on scientific proof, we cannot register them. To give them full registration status, we must know their herbal contents through scientific assessments.”

Imported from Ghana

Somewhere at Cement Bus Stop in the Dopemu area of Lagos State, a young Ghanaian man moved up and down the frustrating traffic jam that held commuters spell-bound, peddling what he describes as blood-purifying tonic.

This time, it is Asheitu Adams Bitters Blood Purifying Tonic which, he says, is blood tonic. However, the label on the ill-packaged and already fermenting mixture says it is “made from natural combined herbs that suits (sic) the human body.”

Also a cure-all and allegedly produced “Under the Lab of Centre for Scientific Research Into Plant Medicine, Mampong-Akwapim in Ghana,” Asheitu takes care of “piles stomach trouble, waist pains, anaemia, menstruation problems, ulcer, sexual weakness, worms, fever, headache, rheumatism, eyesight, pregnancy disorder, hypertension, asthma, fibroid and diabetes.”

“It purifies blood and eliminates blood deficiencies,” the label adds.

That’s not all. In case of constipation, the same product can aid digestion and easy bowel movement. It also regulates menstrual period. And being a multi-efficient product, it is also capable of ridding women of premenstrual syndromes such as tender breasts and cramps. And as for men who crash out after a round of sex, a dose of the wonder product will enable them to do five rounds between midnight and daybreak.

Such is the promise held by the seller who claims to be a student of the University of Ghana, Legon, that listeners make mad rush for it, never mind that beyond the spurious claim that it is a “herbal product,” no one could tell for sure what it is capable of doing once ingested. Buyers rely on word of mouth — both of the seller and that of the people who claim to have proved its efficacy.

As with Goko Mixture, women in their first trimester of pregnancy are forbidden from taking Asheitu Herbal Bitters Blood Purifying Tonic; adults are to take “one or two” tablespoons daily, while children “under three years” are to take one teaspoonful every three days.

World of herbal mixtures

Welcome to the world of herbal mixtures, a relatively new trend in Nigerian health sector.

What many buyers and prospective users don’t know is that most of these ‘drugs’ — which are never found in regular pharmacies, by the way — are capable of ruining their health if taken for extended period. It’s even worse when you consider that most users combine them with over-the-counter drugs such as painkillers.

The experience of Mr. Ayodele Oshodi, a 56-year-old bricklayer who made these unregulated products his drugs of choice in treating all sorts of ailments, comes to bear.

He narrates, “The nature of my job makes me feel pain all the time. To counter the pain, I regularly use herbal mixtures to take Alabukun,” (an agelong and popular powdery pain killer that is, however, hardly prescribed formally by physicians).

His self-medication nearly killed him, though, he says. His body started to swell up — his hands, scrotum, legs, stomach, etc. When it was obvious that he might die, his relations took him to the Lagos University Teaching Hospital on November 28, 2013, where he racked up a medical bill of nearly N500,000.

While Oshodi was lucky to have survived his drug abuse, Tijani, an artisan and husband of 24-year-old Modupe wasn’t that lucky. His pregnant wife testifies that he had brought home an unnamed herbal product in a simple pack the day before, which he claimed to have bought in a commercial bus on his way home.

His pregnant widow says he took the haphazardly-named product after his dinner. In the middle of the night and after they had had sex, Tijani started breathing hard and soon started foaming in the mouth. Before help could come, he gave up.

Sold everywhere but in the pharmacy

The dangers inherent in these products are better understood when you consider that, for one, they are never prescribed by orthodox physicians. Again, the manner of introduction leaves much to be desired: they are presented at bus stops, motor parks, in commercial vehicles, and also in moving vehicles by salespersons who dish out the astonishing wonders of the products.

Public Health Specialist, Dr. Rotimi Adesanya, says it’s virtually impossible for doctors to prescribe these products because of many reasons. One, he says, the products are never submitted for the clinical trial protocols, which describe the type of people who may use a drug product, and with the least reactions.

He says, “Every drug must undergo the regulatory agency’s rigorous evaluation process, as the authorities must scrutinise everything about the medicine, ranging from the design of clinical trials to the severity of side effects, to the conditions under which the drug is manufactured.

“You don’t necessarily have these rigorous processes being undertaken by those who manufacture these herbal products; and that tells you a lot about them. In any case, they can’t stand before a physician and make the same claims they make in the marketplace. They surely know better.”

Worsened condition

A cancer patient, Mrs. Anike Olatobi, says she was a firm believer in these herbal products, as many people she had come into contact with touted their effectiveness in tackling any disease, including terminal ones like cancer. Her experience taught her a bitter lesson, though.

Olatobi narrates, “My physician had detected a lump on my right breast during a routine breast examination. He advised that the lump should be removed surgically and sent to the laboratory for analysis in order to determine the appropriate course of treatment.”

But while Olatobi agreed with her doctor that the lump should be removed, her friends and relations soon persuaded her not to return to the physician. Instead, they said, she could try the local herbal preparations that litter the Nigerian market.

She did, but the condition grew worse and the lump became cancerous, eventually spreading to the second breast. Both breasts were finally excised and she underwent several sessions of chemotherapy and radiotherapy that cost tons of money.

Professor of Oncology and Head, Radiotherapy Department, Lagos University Teaching Hospital, Idi-Araba, Remi Ajekigbe, says physicians are used to seeing such reactions in cancer patients. He laments that by the time many of them ultimately decide to return to the hospital for treatment after the initial diagnosis, the deed would have been done, with many of them actually dying because they had delayed too much.

Alcohol or herbs?

The curious thing about these herbal preparations is their high alcoholic content. Take the Baby Oku Original Herbal Drink, for instance. A mere 100ml bottle contains 40 per cent volume of alcohol, and, in addition to its many claims, “it boosts manpower.”

Produced by Chuby-Zion Industries Nigeria Limited, Baby Oku’s active ingredients are listed as water, ethanol, caramel, herbal flavour, extracts such as angelia root, cassia sanna (sic) leaf, rhuherb root and aloe.

Another one is the Yoyo Sappiro Lemon Ginseng Liquor, which “consists of extracts from natural ingredients for healthy and active life sustenance.”

The ingredients are water, ethyly (sic) alcohol, lemon grass plants extracts, panax ginseng, humulus lupulus L, nymphaea alba L, etc. The 120ml bottle contains 42 per cent alcohol.

While researchers agree that alcohol has been used medicinally throughout recorded history, the volume in any concoction is of the essence, and shouldn’t be of damaging level, they warn.

Chemical analysis

Our correspondent took some of these products to the Central Research Laboratory at the University of Lagos, where the chemical analysis of the products were done, using Gas Chromatography with Mass Spectrometry Detector. The extraction of the mixtures’ chemical compositions was done by a group of PhD students, while the Senior Technologist, Mr. Mejida Sumaila, supervised the laboratory analysis.

According to laboratory analysis, Baby Oku contains Carene, a medicinal component of herbal drugs. It also contains eugenol (alcohol), and fatty acids such as propenoic acid and nonanoic acid. There’s also the presence of cyclohexanemethanol in it.

The analysts note that cyclohexanemethanol is a colourless low-melting solid used in the production of polyester resins. Consequently, its use as food or drug is suspect and not recommended.

“Cyclohexanemethanol is not intended for use as drugs, food additives, households, or pesticides,” the scientists warn.

A pharmacist, Mr. Daniel Popoola, says Senna (spelled as Sanna on the bottle) is an herb whose leaves and fruit are used to make medicine.

“It could be used as laxative because it is effective for constipation, irritable bowel syndrome, hemorrhoids and weight loss. That’s when the herb is in its natural form.

“Of course, it is also used in medicine, but there are controversies still surrounding it, hence the need for users to be careful,” Popoola says.

He notes that because of its possible toxic effects, experts warn against long-term use of senna leaf. “Even though senna fruit is a lot gentler on the human system, the leaf isn’t, hence the need for caution,” he enthuses.

Indeed, he says, those who have abdominal pain, diarrhoea, pregnant or are nursing mothers must not toy with any product containing senna leaf. And even where one has been using the product, once any of these side effects begin to manifest after use, the best bet is to stop.

Popoola stresses that since many of these products don’t list contraindications that may result from use, it is better for people to patronise hospitals where their conditions will be properly diagnosed and appropriate treatment offered.

“The dosages are usually unscientific; and users don’t seem to have definite times that they should stop using the products. Even where people have life-threatening diseases, they are not likely to be on the same drug or dosage forever, because many indices change as the attending physician monitors the symptoms,” the pharmacist counsels.

On the use of alcohol as active ingredients in the herbal mixtures, experts say it could be tragic.

“Take Senna, for instance. It contains many chemicals called sennosides, which are known to irritate the lining of the bowel. When this happens, it causes a laxative effect, and that’s why it cannot be used long-term, as we have here,” Popoola says.

He asks, “If they’re medicinal, why have they become choice drinks on social occasions?” Continuing, he says, “It’s even more worrisome when you realise that despite their already higher-than-normal alcohol volume, users still dilute them with energy drinks, while others use them to swallow over-the-counter pain relievers.”

Risk of liver damage, heart disease

There are more dire warnings over this singular ingredient alone, the percentage of which isn’t stated on the bottle.

For one, experts advise against using senna for more than two weeks at a stretch, as “longer use can cause the bowels to stop functioning normally and might cause dependence on laxatives.”

Popoola warns that long-term use of this herb can also change the amount or balance of some chemicals in the blood — a situation that can result in heart function disorders, muscle weakness and liver damage.

Overuse of senna can also make people to develop potassium deficiency, while the same product could cause dehydration if used in excess.

Those suffering from intestinal blockage, Crohn’s disease, ulcerative colitis, appendicitis, stomach inflammation and haemorrhoids are also told to stay off this particular leaf. Yet, haemorrhoids is one of the very diseases it is reputed to cure.

Worse still, physicians say, senna can cause electrolyte disturbances and might make heart disease worse.

And as for interactions with other drugs, Popoola says it’s suicidal for anyone to combine unproven herbal products with orthodox medicine, prescriptive or not.

“When a physician prescribes a drug for any condition, he does so with the knowledge of its possible interaction with other drugs. That is why physicians ask many questions before he proceeds to prescribe drugs. You don’t have that privilege when it comes to these herbal stuffs.

“And by the time you combine an alcoholic herbal mixture with pain reliever, for instance, you would get untoward results that are likely to worsen your symptoms if it doesn’t kill you outright,” he says.

A user of Pasa Bitters Alcoholic Drink, Martins (who refused to give a surname), says characteristically, he develops headache when he takes too much alcohol. To enable him imbibe to his satisfaction, therefore, he reveals, he will first down two packets of Alabukun Powder with 100ml of Pasa, after which he can take as many bottles of any alcoholic beverage as he desires.

Asked if he has been having his medical test as necessary, he says he hasn’t been sick, hence no need for routine medical tests.

Oremiti: Promise of sexual prowress

Oremiti Herbal Energiser is another herbal mixture of choice among users. With 40 per cent alcohol content to its 100ml bottle, it promises unending sexual thrill. With an appellation such as “Afi bi eshin” (referring to a horse’s legendary sexual prowess), Oremiti boasts active ingredients such as Terapleura Tetraptera, Axonopus Compresus, Cnestic Ferruginea, Sorghum Bicolar, Ethanol and water.

Traditionally, Terapleura Tetraptera is used as a spice, but a World Health Organisation study recommends that further study should be done on the appropriate dosage at which it can be safely administered.

Indeed, a study published in the Research Journal of Medicinal Plant by the trio of Dr. Omolola Selina Odesanmi of the College of Medicine, University of Lagos; Dr. Rahman Lawal of the Federal Neuro Psychiatric Hospital, Yaba; and Dr. Sikiru Abiola Ojokuku of the Department of Chemical Science, Yaba College of Technology, concludes that though Terapleura Tetraptera is a plant used to treat various medical ailments, it has been reported that feeding of extracts to animals produced some toxic effects and pathological lesions in some organs.

There is therefore the need for caution when taking herbal preparations containing this leaf.

Axonopus compressus (also called carpet grass), is traditionally used as antidiabetic, but researchers say safety issues compel clinicians to consider the risk-benefit ratio and individualise treatment of patients with any concoction containing this herb. Random users are ignorant of this fact.