Is herbal medicine good for you? Experts weigh in

Wambuzi was one of the exhibitors at the National Science Week at Kololo Ceremonial Grounds in November, displaying products made by Jena Herbals, the company behind the renowned Covidex, a supportive treatment for Covid-19.

Many innovators with different types of herbal medicines were authorised by the Office of the President's Secretariat of Science, Technology and Innovations to display their products. Some products on display had received initial approval from the National Drug Authority (NDA) while others were yet to be approved.

“The product (Jenacid) is notified by NDA. It is a natural syrup, made out of herbs. It also does not have long-term side effects. It works by restoring your stomach walls, healing you naturally,” Wambuzi claims.

Notified?
A notified product is one whose manufacturer has submitted samples and details on its safety to the drug regulator who provides initial approval as the product awaits clinical trials as well as lengthy and expensive scientific procedure to prove cure claims. Records from NDA show that Jenacid was notified in December 2021.

Sharon Tracy Edeya from the Natural Products Research and Innovation Centre at Butsitema University, says one of the products she was showcasing at the Science Week was yet to be notified with NDA.

“We also have Glucotak for the treatment of diabetes although it is still under investigation and is not yet fully approved. However, it has compounds which can lower blood sugars by reducing the levels of glucose in the body,” she says.

“Tazcov, which was notified by the NDA in September last year, cures flu and cough. Initially, it was meant to treat Covid-19 but it has been modified to treat flu, cough and other respiratory tract infections,” Edeya adds. 

Research
Different universities, including Busitema, Gulu, Mbarara, Lira and Makerere are involved in medicinal herbs-related research. Some of their products have already been notified with NDA for use as supportive treatment for common diseases or conditions. This is in addition to the majority of products from other local herbalists and some imported from countries such as India.

Dr Michael Mutyaba, the manager of the herbal medicine division at the NDA, says it is registering an improvement in the quality of herbal medicines in the market.

“Over time, we have noticed that the number of notified herbal products has increased and the quality of submissions has also improved,” he says.

Information from the NDA drug register as of October 2023 indicates that the number of locally made herbal medicines that have been notified now stands at 292, an increase from 152 in 2020.

Dr Mutyaba attributes the improvement in quality to increased collaboration between the Natural Chemotherapeutic Research Institute (NCRI) of the Health Ministry, universities and herbalists.

Through these collaborations, herbalists are trained to ensure they improve the quality of their products since these products are tested for efficacy, Dr Mutyaba says.

Why resort to herbal medicines?
Research reports by Maud Kamatenesi-Mugisha and others put the prevalence of the use of traditional/herbal medicines in the country at somewhere between 70-80 percent.

Many people use herbal or traditional medicine because it is accessible, affordable and culturally familiar, according to the World Health Organisation (WHO). Some people also turn to herbal medicines when conventional medicines do not work, partly because of the rising threat of drug resistance. 

However, lack of adherence to good manufacturing practice, poor regulatory measures and adulteration may lead to adverse events in their use, according to a 2017 report by Merlin Mensah.

Recent reports by NDA indicate that some people who sell herbal medicines for erectile dysfunction were mixing the products with an unknown amount of therapeutic drug (Viagra) to increase their potency, a practice the regulator warns predisposes users to risks of drug overdose and associated dangers.

WHO, in its 2007 guidelines to countries, noted that although the demand for herbal medicines is increasing worldwide, "There is potential for adverse events due to lack of regulation, weak quality control systems and loose distribution channels (including mail order and Internet sales).”

"A resolution on traditional medicine adopted by the 56th session of the World Health Assembly in May 2003, urges member states, where appropriate, to ensure safety, efficacy and quality of herbal medicines by determining national standards for, or issuing monographs on, herbal raw materials and traditional medicine formulae," the WHO wrote.

Dr Grace Nambatya, the director of research at NCRI, says they are training herbalists and educating young people on herbal medicine with the interest of improving the quality of products and integrating herbal medicines with conventional medicines.

Dr Nambatya is the lead developer of the UBV-01N herbal medicine which has been subjected to clinical trials for treatment of Covid-19 patients at Mulago National Referral Hospital. 

When should one avoid herbal medicines?
Some doctors are concerned that herbalists are being given too much liberty, a move they say could "hurt" public health. 

Information from the National Health Service (NHS) of the United Kingdom indicates that although herbal medicines may be "helpful", they may "cause problems if you are taking other medicines. They could make the other medicine less effective or cause the other medicine to trigger unexpected side effects."

As a result of potential side effects, the NHS advises those taking other medicines, including hormonal contraceptives, such as the combined pill to avoid taking herbs. The agency also advises those with serious health conditions such as liver or kidney disease, those waiting to have surgery and pregnant or breastfeeding women, to also avoid herbal medicines.

Dr William Lumu, the president of the Uganda Diabetes Association, warns diabetics against using herbal medicines for treatment, saying it increases the risk of severe complications and death. He adds that about 80 percent of diabetes patients have been lured by herbalists to use the concoctions as treatment at some point.

“I have seen many people coming to the hospital after taking herbal medicine and suffering worse side effects. They then want us to provide treatment, but how do you expect us to troubleshoot things we are not sure about?” he asks.

Dr Lumu says effective diabetes treatment, which improves a patient’s quality of life, goes beyond only controlling blood sugar.

“Diabetes is multi-systemic. We have issues with the eyes, teeth gum, the heart, liver and kidneys which can be affected by the condition. If you summarise all those issues into only blood glucose, then that is very unfortunate. Are you saying the medicine that reduces blood glucose will solve all the other issues?” he adds.

How herbal medicine is validated
Dr Nambatya, who is also a member of the NDA Board, says for a product to be validated and allowed into the market, it must complete the initial approval process, which takes about three months.

“When you have a product (herbal medicine), you should bring the samples to us [NCRL) for assessment on safety,” she notes.

Joseph Muyanja, an ethnobotanist at the Department of Plant Sciences at Makerere University who also assesses herbal products, says they analyse herbal medicine for specific plant chemicals which kill bacteria, fungi or viruses.

“The phytochemical tests (assessing plant chemicals of medicinal value) costs around Shs100,000. After this, the toxicity tests are done to ensure the product is not harmful. This requires around Shs150,000 and the developer must buy laboratory animals (guineas pigs or rats) to use for trials,” he said.

Dr Nambatya says after successfully completing the steps, the NDA verifies the results and validates a product so that the developer can proceed to do mass manufacturing and sales. She, however, warns developers not to use the word “cure” but to talk about their products as “supplements” as the law requires.

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