If you watch TV ads, you might think that at the first sign of a runny nose, aching tummy, or painful joint everyone runs to a drugstore for medication. But for many Hispanics in the United States, the first reaction to those symptoms is to call their mother or "abuela" (grandmother) to ask how to prepare the family's signature remedy. With that recipe in hand, the next step is often shopping for ingredients at a local botánica.
Botánicas are stores that sell medicinal plants, religious objects, and other artifacts for physical and spiritual healing. People look to botánicas for a familiar, traditional approach to treating their illnesses, sometimes mixed with spiritual advice and all in their own language and cultural context. A botánica is a place where folk medical traditions intersect with centuries of religious beliefs. Botánicas flourish in many U.S. urban areas, following the domestic migration patterns of the Hispanic community.
For example, nursing student Nearco Rodriguez, 28, is originally from the Dominican Republic and has lived in Brooklyn, N.Y., since 1996. "If I feel a sore throat, I prepare my mom's recipe," he says. He stirs an infusion of chamomile, star anise, cinnamon, and linden tea, with a few drops of lemon juice and a teaspoon of honey. "This is my first choice before taking any type of medication," Rodriguez says. "I either get the ingredients at a botánica located close to my job in the Bronx or at the supermarket."
Decades ago, botánicas were probably the only places you could find a wide variety of these herbs, but now supermarkets in Hispanic neighborhoods also sell many Latino products. And ethnic wellness stores have appeared as alternatives to botánicas. Some, such as Cuevas Health Foods in Los Angeles and Rico-Perez Products in Miami and the New York metro area, sell their own brands of dietary supplements.
Using herbs to treat conditions that are usually get better on their own, like colds and upset stomachs, may be fine, but what about treating more serious conditions?
Consumer Reports sent a Spanish-speaking reporter to a handful of botánicas in the New York City area. He asked for advice on how to treat type 2 diabetes and high blood pressure, for which very effective prescription medications are available. He also purchased samples of some of the recommended herbs so that he could assess packaging methods, labeling, and information on adverse drug reactions. The results of the investigation reveal some positive and some potentially worrisome facts about botánicas and the practice of alternative medicine in the Hispanic community.
On the positive front, just walking into a botánica may feel like a healing experience. One store in the Bronx felt like a soothing urban oasis. There were manicured altars dedicated to saints and deities, and the air was thick with aromas from burning incense sticks. That atmosphere can lead to a consultation with the in-house healer, who may be the owner. The healer may be a practitioner of "curanderismo," a form of folk medicine that includes herbal remedies; "Santería," which uses the healing power of plants; "Palo," a belief in natural powers; or "espiritismo," which can involve purification with herbs.
"Because they offer traditional cultural connections that can give emotional and spiritual support when you're battling a disease or treating a chronic condition, botánicas are important purveyors of health care and wellness in the Hispanic community," says Jose Luis Mosquera, M.D., a Consumer Reports medical adviser and associate professor of clinical medicine at the University of Arizona College of Medicine.
Our consults focused on herbal treatments for these common conditions: high blood pressure, type 2 diabetes, and impotence.
The resulting advice was less soothing than the atmosphere. Healers offered a variety of different instructions and products for treating those ailments, but none volunteered relevant facts about possible side effects from the treatments or the risky interactions that can occur when an herb is taken along with a medication.
The Bronx botánica owner, for example, recommended hibiscus leaves to treat high blood pressure. The treatment has a little clinical support. A study of 65 adults published in February 2010 in The Journal of Nutrition found that hibiscus lowered blood pressure over a period of six weeks in prehypertensive and mildly hypertensive adults. The healer also recommended logwood and fenugreek to treat type 2 diabetes, and damiana, sarsaparilla, and saw palmetto for impotence. All of those were sold in brown paper bags, without labels or instructions.
At another store, in Jackson Heights, Queens, we were offered prepackaged "blended herbs" to treat different conditions. The label, which said the herbs were imported from Peru, provided instructions in English and Spanish, an ingredients list, nutritional facts, and a freshness date.
After checking the scientific evidence for the prescribed herbal remedies we purchased, we found that they all lack conclusive research on their efficacy and safety.
Along with taking advice from their mothers and botánica owners, some Hispanics turn to herbalist doctors who prescribe products for their conditions. For example, Teresa Alonso, 59, an aerospace electronic assembler from Northridge, Calif., uses herbal products to complement conventional medicines to treat her high cholesterol and high blood pressure. Alonso visits Jaime Cuevas Duran, an herbalist who sells his own brand of dietary supplements in Los Angeles.
Alonso says she first learned about herbal remedies from her mother and used them while raising her two children. "However, I do my own research online before taking new supplements, and I do ask my doctor. For example, I drink 'agua de Jamaica,' or hibiscus flower tea, to lower my cholesterol and drink mint tea for stomachache," she says.
It's not clear how many Hispanics use these types of remedies. Government statistics show that only about 24 percent of Hispanics use complementary or alternative medicine, compared with about 26 percent of African Americans, 40 percent of Asians, and 43 percent of whites.
In reality, those rates might be higher because of low disclosure rates between health professionals and patients. That may be because patients expect their doctors and nurses to initiate the discussion or because patients have the impression that health-care providers know little about those treatments. Or may fear that the health-care provider will discourage using complementary or alternative medicine.
The botánicas industry is not formally organized. In the U.S., Latino herbal shops are not governed by any association or organizing body, and we couldn't locate statistics about how many stores are actually out there. Only a handful of scientists and folklorists have studied businesses in the Los Angeles, Washington, D.C., and New York City areas.
For instance, Michael J. Balick, Ph.D., vice president for botanical science, director and philecology curator at the New York Botanical Garden's Institute of Economic Botany, conducted long-term research focusing on Latino and other immigrant groups in New York City. "We confirmed the widespread use of medicinal plants among Latinos, in this case Dominicans, even after migrating to the U.S.," Balick says.
The transition from true folk medicine, relying on traditional plants grown in home gardens or collected in the wild, to commercial sales in botánicas, "yerberías," a synonym of "botánicas," or "bodegas," neighborhood Hispanic convenience stores, can be a bumpy one. Potential concerns include accurate product identity, freshness, contamination with heavy metals and pesticides, and interactions with medications.
"There is a concern about quality, starting with identity," says Mark Blumenthal, founder and executive director of the American Botanical Council, a nonprofit research and education organization, and editor of the publication HerbalGram. "I don't know that the importers, distributors, or buyers are running these herbal materials through any kind of identity testing." He also said some ethnic stores (including Indian or Chinese herbal shops) might have a supply chain that often bypasses best practices on selection and safety.
The federal Dietary Supplement Health and Education Act of 1994 classified herbs and dietary supplements as food additives. The Food and Drug Administration has exclusive jurisdiction over the safety of dietary supplements and primary jurisdiction over their labeling.
In the legislation, the FDA was called upon to develop good manufacturing practices (GMPs) guidance for the supplement industry, but 13 years passed before the agency put those guidelines together. The FDA published a final rule for GMPs in 2007. It recommends quality-control systems, production and process controls, and record-keeping procedures, to name a few. But none of those recommendations is obligatory. Therefore, like other industry players, botánica owners aren't required to take on the responsibility of stepping up their quality controls and requiring suppliers to test for microbials, pesticides, or adulterations.
Because there is little or no oversight on industry compliance with GMPs, the consumer of dietary supplements must remain vigilant. If you're shopping for supplements manufactured in pill form, look for the small number of products verified by the U.S. Pharmacopeia, the federally recognized authority that sets voluntary standards for health products. Those products have a "USP verified" mark on their label. They have been tested for identity, purity, and dangerous contaminants.
Some storeowners in the Hispanic community are listening. Martín López, managing partner of Herbs of Mexico, an herbal retail chain with three stores in Southern California and an online store, is raising the bar on product safety. "We're trying to legitimize the use of these health and wellness products and appeal to those who are adamantly looking for organic and paraben-free goods," Lopez says.
Furthermore, he claims that his company demands a certificate of analysis from suppliers; pays for independent testing for the presence of microbials, such as E. coli and salmonella; sterilizes all raw products they import themselves, using steam; and carries product-liability insurance. In his opinion, owners of botánicas might have a hard time implementing best business practices because of the language barrier and lack of business administration skills.
"These markets should not be singled out, but they also should not be exempt from meeting the same standards required by other purveyors of herbal and dietary supplements," says Tieraona Low Dog, M.D., clinical associate professor of medicine at the University of Arizona Health Sciences Center and fellowship director of the Arizona Center for Integrative Medicine. "I think public education is key and that there should be more focus in reaching out to Spanish speakers, so they can make more informed and educated decisions with regard to the use of herbal remedies," she adds.
Mixing healing and spiritual techniques with conventional medical treatment could be a potent combination. "We still have a long way to go on understanding how Latinos use complementary and alternative medicine," says David Hayes-Bautista, Ph.D., professor of medicine and director of the Center for the Study of Latino Health and Culture at the School of Medicine at UCLA. "Most of these herbs have been used for generations, but their use may not be entirely risk-free. Mixing healing and spiritual techniques with conventional medicine might brings benefits to some patients."
These tips can help you minimize the risks of using herbal medicine:
Remember that natural does not equal safe. There are natural plants (such as belladonna and certain mushrooms) that are fatally poisonous. Some herbs and supplements may cause you harm if you're pregnant, nursing, about to have surgery, or taking prescription medicines for an acute or chronic condition.
Don't mix medications and herbs on your own. Herbal remedies can decrease the effectiveness of some prescription drugs and increase the potency of others. That can lead to you getting more or less effective medication than you need. For example, garlic can increase the blood-thinning effects of anti-coagulant and anti-platelet drugs and might increase the effects of certain diabetes drugs. Garlic may also decrease the effectiveness of birth-control pills. So talk to the medical professional who prescribed the medication before mixing it with herbs.
Seek a trained practitioner. It is important to find a trained herbalist because not all forms of an herbal medicine produce the same effects. For example, tea made from saw palmetto probably has no health benefits because the active compounds don't dissolve in water. In addition, different parts of the same herb can have different effects. Dandelion leaves may act as a diuretic, but the roots act as a laxative. Remedies made from sassafras root may contain safrole, a noted carcinogen, and even those that say "safrole free" might not be.
Be wary of private-label supplements. Some doctors and other health practitioners sell their own brand of supplements, and that may be problematic. When those products are sold for profit by the same person who prescribes them, it creates a potential conflict of interest for the doctor and puts pressure on the consumers to buy them. The American Medical Association and the American College of Physicians recommend that physicians who distribute nonprescription health-related products provide them free of charge or at cost. That removes the temptation of personal profit that can interfere with the physician's objective clinical judgment.
Consider seeing an integrative physician. "Integrative medicine is a holistic healing method, based on clinical evidence, in which the patients' traditions and cultural background are take into consideration and used as part of their treatment," Mosquera says. It has gained traction over the years, and it is now practiced at some of the leading medicine faculties across the nation.
"There are 50 academic health centers that belong to the Consortium of Academic Health Centers for Integrative Medicine," notes University of Arizona's Low Dog. "As the scientific base grows, the inclusion of these practices in conventional medicine also grows," she says.
This report was made possible by a grant from the Airborne Cy Pres Fund, which was established through a legal settlement of a national class-action lawsuit (Wilson v. Airborne Health, Inc., et al.) regarding deceptive advertising practices.