Herbal Supplement Use for Evidence-Based Indications in US Adults: An Analysis of National Survey Data

Abstract

Objective:

Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use.

Methods:

Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use.

Results:

Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70–5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26–2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28–0.66]) compared with non-EBI use.

Conclusion:

Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population.

Introduction

Reports from 2000 to 2012 suggest a nearly 200% increase in nonvitamin, nonmineral dietary and herbal product use in U.S. adults.^1

–6 How consumers decide which products to use and whether the decision is supported by evidence remain unclear.

Prior evidence analyzing the 2002 National Health Interview Survey (NHIS) suggests that most (55%) participants claiming herbal supplement use for a specific reason did so in alignment with evidence-based indications (EBIs) that had been identified in the 2007 Natural Medicine Comprehensive Database (NMCD).¹ Limitations in this earlier data, however, leave a gap in their ability to determine what influenced supplement use.

Evidence-based herb use relies on available evidence. Evidence continues to evolve from traditional and historical medical systems relying upon observations and experiences of practitioners being passed down through the generations to inform modern scientific research. Some estimates suggest that worldwide, herbal medicine research plateaued between 2011 and 2019, at about 5000 new publications each year.⁷ Research on EBIs for herb use has relied solely on peer-reviewed evidence, which is often guided by both tradition and popular use.^1,2,6

What wasn't considered an EBI use in 2012, due to lack of research, may have gained support by 2019. Without clear evidence, clinical knowledge must guide health care decisions.⁸ In the United States, consumers can obtain herbal products over the counter with no clinical oversight. Broad claims by manufacturers, easy access, and limited oversight leave little understanding of what guides herbal supplement use. The purpose of this study is to determine: (1) association between herbal supplement use reasons given in 2012 and EBIs of 2019, and (2) whether EBI use is associated with practitioner consultation or informational resource types.

Methods

Study design

This cross-sectional study consisted of a secondary data analysis using data from the 2012 NHIS⁶ and information captured in 2019 from the NMCD.⁹ Data from the NHIS provided information on how participants were using herbal products to treat various conditions, while NMCD data provided information on how herbal products should be used based on known EBIs.

NHIS user-reported conditions for taking herbal products were compared with 2019 NMCD herb-condition evidence ratings to determine whether use reasons aligned with an accepted EBI, creating a binary categorical variable representing EBI or Non-EBI use.¹⁰ Three-way consensus aligned 2012 NHIS and June 2019 NMCD conditions. Disagreements in condition alignment were settled by group discussion. The full listing of comparisons between the NMCD and NHIS conditions can be found in Supplementary Table S1.

Participants

Participants of the NHIS were derived from a sample of noninstitutionalized, U.S. citizens. The specific data sets used include the Sample Adult and Alternative Health supplement surveys, incorporating data for those aged 18 and older. For the 2012 NHIS survey, 34,525 adults completed interviews, forming a response rate of 79.7%.¹¹

National Health Interview Survey

The NHIS is an annual public health survey conducted by the National Center for Health Statistics and Centers for Disease Control. The primary purpose of the NHIS is to track data that report on the health status of the U.S. population. Results from this survey provide valuable information on a broad range of health topics.^11
–13 Self-report data are collected through computer assisted personal interview.¹⁴ The 2012 dataset is the last available data where herbal supplement use was queried. In addition, the 2012 NHIS is the only known nationally (US) representative data set to include herbal supplement use, guiding resources, and health practitioner engagement regarding it.

If respondents of the 2012 NHIS reported the use of a non-vitamin/mineral dietary supplement in the past 12 months, they were asked to specify from a list of 98 specific herbal supplements. Respondents are then queried as to which of the Complementary and Alternative Medicine therapies listed that they considered their top three most important and whether they used these therapies for a particular condition. Those reporting use for a specific condition could then specify from a list of 88 health conditions.

The top 10 most reported herbs from the 2012 NHIS were cranberry, echinacea, garlic, ginseng, milk thistle, green tea, Ginkgo biloba, acai, saw palmetto, and valerian. The operational definition of “herbs” for these purposes was determined by Johns Hopkins Medicine's¹⁵ definition of a herbal product and the documentation in more than one Materia Medica.^16
–18

Natural Medicines Comprehensive Database

The goal of the NMCD is to provide health care professionals and their patients current evidence summaries for natural medicines. Experts in the field use peer-reviewed literature to establish a rating for each of the therapies included in these summaries. As per NMCD's website, they do not use traditional knowledge, manufacturer promotional material, sponsored studies, or take payment from advertising. Summaries are graded by relevance, validity, and consistency to determine safety and efficacy ratings for each herb.⁹

For their purposes, only the conditions where NMCD rated a herb as Effective, Likely Effective, or Possibly Effective were considered EBI use in this analysis. To achieve the lowest accepted level of “Possibly Effective,” a herb/condition pairing had to have at least one randomized clinical trial/meta-analysis, or two or more population based epidemiological studies with a high-quality rating (low–moderate risk of bias), which shows positive outcomes for the indication, without substantial valid evidence to the contrary.

Variables

The outcome variable of interest was EBI use of one of the top 10 most popular herbs from the 2012 NHIS. Predictor variables included the following: (1) respondent characteristics (age, self-identified gender, race/ethnicity, education, health insurance coverage status, and online health information seeking behavior), (2) the top 10 reported herbs for 2012, (3) interactions with clinicians about herb use, and (4) the reported informational resources guiding herb use.

Top 10 herbs

The sample was derived from the 2012 NHIS data sets, using the same approach to sample size determination as prior works.¹ The options for herbs have expanded since 2002, which led to supplements that weren't considered earlier being incorporated.¹⁹ At the time of this analysis, there were no conditions related to Acai that met NMCD's minimum effectiveness criteria, so this was excluded from the primary analysis. Their final eligible population consisted of those who reported using one of the remaining top nine herbs in the prior year for a specific condition and rated this herb as one of their three most important complementary and alternative medicine (CAM) therapies. Since participants could have chosen multiple herbs, the study sample reflects each herb as used per condition.

Statistical methods

Descriptive statistics for continuous variables included means, standard deviations, medians, and IQRs for continuous variables. For descriptive characteristics, stratified groupings were compared across degrees of herbal supplement use (user, nonuser, top-three user, and EBI user). Continuous variables were analyzed using t test, and categorical variable count and percentages were analyzed using chi squares in characteristic comparisons. Logistic regression examined the relationship between the outcome variable and predictor variables. All analyses were completed in R version 3.6.1. Covariates were selected based on prior evidence and results of the descriptive demographics. Any variable demonstrating a statistically significant (p < 0.05) difference between groups and included in similar reports was considered for inclusion.^1,2,6 Analyses were performed for adjusted and unadjusted for covariates. The main results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Sampling weights were applied using the R package “Survey” to account for the complex sampling design of the NHIS.

Results

Participants

Of the 34,525 respondents within the 2012 Adult Sample, only 17.3% (n = 5974) reported consuming a specific herb within the past 12 months of the study period. Of these specific herb users, 67.3% (n = 4018) chose a supplement as one of their top CAM therapies, but only 238 reported using a herb for a specific condition. There were 184 reported uses of one of the top 10 herbs for a specific condition. These 184 uses constitute the final data set, including Acai, which only accounts for 3 of the total uses (Fig. 1).

FIG. 1.

Study flow diagram.

Descriptive data

Most (57.4%) of the participants who chose herbs as their top therapy (n = 4018) identified as female. The mean age of the herbs as a top therapy group was 52.69 ± 16.67 with the majority identifying as Non-Hispanic, White (74.5%). Many participants (71.3%) citing herbs as one of their top three therapies of choice also reported higher levels of educational attainment (71.3%), having health insurance (87.2%), and above high school/GED level. Most (87.2%) participants selecting herbal products as their top therapy reported having health insurance coverage as well. A majority of participants who rated herbs as one of their top three therapies reported seeking health information from the internet (57.5%) (Table 1).

Table 1.

Sample Characteristics Stratified by Herb Use and Rating Herbs as Top Therapy

	Pooled	Nonherb user	Herbs used, NOT top therapy	Herbs used, top therapy rated	Missing %
n	34,525	28,551	1956	4018
Age, mean (SD)^a,c	48.53 (18.17)	48.24 (18.40)	44.19 (15.99)	52.69 (16.67)	0.0
Gender = male, n (%)^b,c	15,273 (44.2)	12,782 (44.8)	779 (39.8)	1712 (42.6)	0.0
Race/Ethnicity, n (%)^a,c					0.0
Hispanic	5859 (17.0)	5223 (18.3)	259 (13.2)	377 (9.4)
Non-Hispanic, White	20,842 (60.4)	16,502 (57.8)	1345 (68.8)	2995 (74.5)
Non-Hispanic, Black	5282 (15.3)	4714 (16.5)	213 (10.9)	355 (8.8)
Non-Hispanic, Asian	2168 (6.3)	1794 (6.3)	119 (6.1)	255 (6.3)
Non-Hispanic, Other	374 (1.1)	318 (1.1)	20 (1.0)	36 (0.9)
Educational attainment, n (%)^a,c					0.4
No diploma	5487 (16.0)	5031 (17.7)	137 (7.0)	319 (8.0)
Diploma/GED	8938 (26.0)	7790 (27.4)	315 (16.1)	833 (20.8)
Higher education	19,947 (58.0)	15,588 (54.9)	1502 (76.9)	2857 (71.3)
Health insurance = covered, n (%)^a,c	28,257 (82.1)	23,143 (81.3)	1612 (82.8)	3502 (87.2)	0.3
Online health info seeking = yes, n (%)^a,c	13,674 (40.3)	10,038 (35.9)	1324 (67.7)	2312 (57.5)	1.8

For comparison of herbs top therapy versus herbs NOT top therapy: a = <0.001; b = <0.05; for nonherb users versus herbs NOT top therapy versus herbs top therapy: c = <0.001.

GED, general educational development; SD, standard deviation.

Evidence-based herbal supplement use

Of the total (n = 181) top herb uses for a specific health condition, 63.5% (n = 115) of those reported uses were consistent with EBI. Cranberry supplements contained both the highest proportion of reported uses (32.6%) and the highest proportion of uses consistent with EBIs (41.7%). Green Tea/Epigallocatechin gallate (EGCG) supplement use contained the lowest proportion of those consistent with EBIs. When all herbs were combined, those identifying as males were significantly less likely (OR = 0.62, 95% CI [0.44–0.88]) than females to use herbs consistent with EBI. Odds of herb use consistent with EBI were significantly increased for participants reporting Higher Educational attainment (OR = 3.01, 95% CI [1.70–5.34]) (Table 2).

Table 2.

Comparison of Demographic Characteristics with Evidence-Based Indication Consistent Herb Use

	Use NOT consistent with EBI, n (%)	Use consistent with EBI, n (%)	Uses based on evidence, OR [95% CI] ^a
N	66	115	181
Age, mean (SD)	47.97 (16.04)	48.25 (19.32)	1.01 [1.00–1.02]
Gender: male	26 (37.7)	33 (28.7)	0.62 [0.44–0.88]^*
Race/Ethnicity^b
Non-Hispanic, Black	7 (10.1)	13 (11.3)	Referent
Non-Hispanic, Asian	3 (4.3)	6 (5.2)	1.15 [0.38–3.49]
Non-Hispanic, Caucasian	48 (69.6)	90 (78.3)	1.83 [1.48–2.27]^*
Hispanic	11 (15.9)	6 (5.2)	0.44 [0.16–1.25]
Educational attainment
Diploma/GED	15 (21.7)	17 (14.8)	Referent
Higher education	52 (75.4)	87 (75.7)	3.01 [1.70–5.34]^*
No diploma	2 (2.9)	11 (9.6)	13.04 [7.55–22.50]^*
Health insurance = NO insurance	5 (7.6)	16 (13.9)	2.15 [1.11–4.16]^*
Online health info seeking = yes	40 (60.6)	68 (59.1)	0.96 [0.58–1.59]

Survey weighted univariate logistic regression model.

“Non-Hispanic, other” category was excluded due to lack of top 10 herb use for a specific reason.

Statistically significant (p < 0.05).

CI, confidence interval; EBI, evidence-based indication; GED, general educational development; OR, odds ratio; SD, standard deviation.

In the weighted multivariable model (Table 3), use of Cranberry supplements was significantly more likely (p < 0.001) to be in accordance with EBI (OR = 8.73, 95% CI [4.94–15.44]). Saw Palmetto (OR = 36.35, 95% CI [4.10–322.38]) and Valerian (OR = 11.80, 95% CI [1.42–97.99]) were significantly more likely to be used in accordance with EBI. Green Tea/EGCG (zero EBI uses reported), Milk Thistle (OR = 0.04, 95% CI [0.03–0.05]), and Ginseng (OR = 0.15, 95% CI [0.05–0.41]) were significantly less likely to be used based on EBI. For many of these supplements, the smaller sample sizes yielded highly imprecise CIs. Evidence-based uses of Echinacea, Garlic, and Ginkgo Biloba were insignificant compared to the number of uses lacking evidence base.

Table 3.

Comparison of Individual Herbs with Evidence-Based Indication Consistent Herb Use

	Use NOT consistent with EBI, n (%)	Use consistent with EBI, n (%)	Uses based on evidence, OR [95% CI] ^a	Uses based on evidence, OR [95% CI] ^b
n	66	115	181	181
Top used herbs^c
Cranberry	11 (16.7)	48 (41.7)	6.91 [4.44–10.75]^*	8.73 [4.94–15.44]^*
Echinacea	11 (16.7)	28 (24.3)	0.99 [0.69–1.43]	1.04 [0.59–1.83]
Garlic	8 (12.1)	14 (12.2)	0.77 [0.57–1.06]	0.93 [0.58–1.48]
Ginkgo Biloba	3 (4.5)	11 (9.6)	2.02 [1.10–3.70]^*	1.53 [0.78–3.01]
Saw Palmetto	1 (1.5)	6 (5.2)	29.87 [3.60–247.79]^*	36.35 [4.10–322.38]^*
Ginseng	10 (15.2)	5 (4.3)	0.16 [0.06–0.44]^*	0.15 [0.05–0.41]^*
Valerian	1 (1.5)	2 (1.7)	10.19 [0.97–106.70]	11.80 [1.42–97.99]^*
Milk Thistle (Silymarin)	12 (18.2)	1 (0.9)	0.04 [0.03–0.04]^*	0.04 [0.03–0.05]^*
Green Tea/EGCG	9 (13.6)	0 (0.0)	0.00 [0.00–0.00]^*	0.00 [0.00–0.00]^*

Survey weighted multivariable logistic regression model unadjusted.

Survey weighted multivariable logistic regression model with age, sex, ethnicity, and education as covariates.

Acai removed from analysis, n = 3 users.

Statistically significant (p < 0.05).

CI, confidence interval; EBI, evidence-based indication; EGCG, Epigallocatechin gallate; OR, odds ratio.

Health care professional interaction and information sources

In adjusted logistic regression models (Table 4), participants using herbs consistent with EBI were significantly more likely to disclose their herb use to a health care practitioner (OR = 1.77, 95% CI [1.26–2.49]). Conversely, herb use consistent with EBI was significantly less likely to have been guided by information from the media (OR = 0.43, 95% CI [0.28–0.66]).

Table 4.

Comparison of Health Care Professional Interaction and Reported Information Sources for Herb Uses Consistent with Evidence-Based Indication

	Use NOT consistent with EBI, n (%)	Use consistent with EBI, n (%)	Uses based on evidence, OR [95% CI] ^a	Uses based on evidence, OR [95% CI] ^b
Disclosed use to health care professional	24 (36.4)	52 (45.2)	1.49 [1.08–2.06]^*	1.77 [1.26–2.49]^*
Saw herbalist past year	5 (7.6)	5 (4.3)	1.48 [0.55–4.02]	1.91 [0.79–4.62]
Use info from internet	17 (25.8)	30 (26.1)	1.47 [0.82–2.62]	1.62 [0.84–3.11]
Use info from scientific art	7 (10.6)	7 (6.1)	0.83 [0.36–1.88]	0.83 [0.34–2.03]
Use info from media	26 (39.4)	24 (20.9)	0.39 [0.25–0.60]^*	0.43 [0.28–0.66]^*

Survey weighted multivariable logistic regression model unadjusted.

Survey weighted multivariable logistic regression model with age, sex, ethnicity, and education as covariates.

Statistically significant (p < 0.05).

Discussion

This study expands upon current evidence of herb use for EBI. Most herb users self-identified as female, non-Hispanic White, with higher education. Demographic trends seen here are reflected in other research on complementary health approaches.^2,6 Since 2007 the overall use of the most popular herbs for EBI has increased from 54.9% to 63.5%.¹ Milk Thistle, Green Tea/EGCG, and Ginseng Supplements were not often used for reasons that aligned with EBI. Some possible reasons for this include the conflation of research focused on whole herbs with that focused on individual isolated herbal constituents. By combining the outcomes of this research there is the assumption that the isolated constituent and the whole plant extract work the same in the body. For example, in vitro studies suggest that there may be a difference between a green tea extract and isolated EGCG supplement.²⁰

In addition, the 2012 NHIS questionnaire did not distinguish between different plants known by their common name (i.e., ginseng). It is also possible that there is a lack of full alignment between traditional medicine usage and what is chosen to be experimentally studied with modern scientific research. For example, traditionally Panax ginseng is indicated as a Shen tonic that nourishes the heart and helps to restore a sense of equilibrium and well-being. EBIs however focus more on the treatment of diseases like diabetes, common cold, bipolar disorder, and Herpes simplex virus type-2 (Supplementary Table S1), illustrating potential misalignment.

In contrast to prior evidence,¹ Echinacea use was not significantly more likely to align with EBIs. Despite the increase in use of herbs for EBI, almost 40% of 2012 use was reported for reasons that were still unsupported in 2019 further demonstrating a need for collaboration between traditional healers and researchers.

Consumers may be receiving mixed messages between science and media reporting, which may also explain this disconnect.²¹ A significantly higher proportion of herb users reported seeking out health information online compared with nonherb users. In fact, internet and media were found to be the most reported sources of information guiding herb use. Health information on the internet is still growing, and reported use of the internet to obtain herb use guidance may be even higher if evaluated today.²² Those who reported media as a resource guiding their herb use had significantly lower odds of EBI use. Therefore, to understand why herbs are being used for reasons inconsistent with EBI, the authors may want to examine how online and media resources convey the evidence.

Tradition-based knowledge may also influence herb use. Scientific research on herbs was not the only type that increased between 2002 and 2012. Ethnobotanical research also showed a 6.3-fold increase between 2001 and 2013.²³ This research provides greater transparency to practices deeply rooted in cultures that may also influence herb use. The World Health Organization's Traditional Medicine Strategy 2014–2023 calls for the incorporation of traditional and complementary medicine into the current health care system in a way that is safe, qualified, and effective.²⁴ Even if the authors were to solve the issue of adequate evidence, failure to include traditional underpinnings in herbal research may still leave a disconnect between the indications supported by science and cultural practices. Various approaches of incorporating community input in both scientific research and public health interventions related to the use of herbs are essential for connecting the science and the cultural practices in a community.

Most herbal products are designated as dietary supplements. Federal regulations prohibit manufacturers from including promotional materials regarding their intended use to “treat, diagnose, cure or prevent diseases.”²⁵ As a result, the manufacturers of the supplements would not be a source of EBI beyond structure-function claims for the consumer. The National Center for Complementary and Integrative Health has made efforts to summarize evidence for the consumer with their Herbs at a Glance website.²⁶ Herbs at a Glance is a valuable resource, but it does not take the place of a trained evidence informed herbal practitioner.

Finally, whether consumers are depending on clinicians for information about herbal supplements may also play a role in evidence-based use. Prior evidence suggests that somewhere between 33% and 44% of patients disclose herbal supplement use to their health care practitioners, which aligns with this study's findings.^27,28 In addition, the authors found that those who disclosed use to practitioners were more often EBI users. Reported reasons for nondisclosure include fear of practitioner disapproval, short office visits, and belief that the practitioner doesn't know enough about complementary medicine.²⁹ Informing general physicians of this may improve outreach to supplement users.

Failure to disclose herb use to practitioners may reflect issues with accessibility to practitioners who are knowledgeable about complementary medicine.^27,28 Few herb users here reported seeing a herbalist in the past year, regardless of EBI use. The reasons herb users might choose to self-treat without guidance of a professional herbalist are still unclear. Herbal practitioners trained in evidence informed practice like Registered Herbalists and naturopaths could offer direction on how to navigate the iterative process of evidence formation. The evidence-informed herbalist merges tradition-based knowledge and patient perspective with research. Reluctance to integrate these practitioners into health care creates barriers to integrative care.²⁹ Future research, therefore, could examine barriers and facilitators to herbalist integration within such settings.

Limitations

Several limitations exist for consideration when interpreting these results. Since NHIS data are cross-sectional, the authors cannot assess the effect of EBI or changes in evidence on variation in herbal supplement use patterns over time. Between the NHIS 2012 data and 2019 NMCD data, evidence changed, and this may have impacted whether use was categorized as evidence based or not at the time of response. The peak of evidence production in herbal medicine research was around 2011,⁷ so if responses were going to be based on evidence, 2012 would have been an ideal time to observe it. This also highlights the connections that are formed between use grounded in tradition and an eventual examination under peer review.

Although data were nationally representative, and survey weighted, the authors limited the sample to those reporting use of a common herbal supplement as one of the top three ways to treat medical conditions. The restriction was necessary due to branched logic question lines used by NHIS. Results of these analyses should be considered with this sample reduction in mind and its effects of lowering precision of the estimates.

The set responses may also conflate whole plant and herbal constituent EBIs, which may have impacted results. For example, the NHIS asked about “green tea pills” or “EGCG pills” together and NMCD also listed green tea/EGCG together. Involving evidence-informed herbalists in research design may have avoided this ambiguity. Research should also seek to clearly distinguish isolated constituents and whole herb products in reporting.

Finally, responses were self-reported, which may hinder accurate estimates. Although NHIS respondents were provided a list of herbal supplements to choose from, there was no way to further clarify survey responses if participants were even aware of differences in the form of supplements available.

Conclusions

While there has been an increase in alignment between EBIs and the reasons cited for taking commonly used herbs,¹ there are still some concerns. The authors saw a larger proportion of herb consumers who are using herbs in alignment with EBIs disclose their use to physicians compared with non-EBI users. When it comes to CAM therapies, a reciprocal relationship is seen where use drives evidence formation and vice-versa. Rationales that weren't evidence based in 2012 may have become EBIs in later years because usage patterns influenced research initiatives. This highlights the importance of seeking out knowledgeable professionals, especially when evidence is lacking, as EBI users seem inclined to do.

Footnotes

Acknowledgment

The authors thank Siobhan Maty, MPH, PhD for her support with the conceptualization and methodology.

Authors' Contributions

D.N. and M.M.: contributed to the project's initial conception, methodology, and writing—original draft and editing/reviewing. D.N.: study protocol design; methodology; supervision; data curation; formal analysis. D.M.: writing-review and editing. All authors read and approved the final article.

Ethical Approval

The Maryland University of Integrative Health IRB determined that this study was exempt under 45 CFR 46.101(b)(2) (04.NAU.IS8.05.19.03).

Author Disclosure Statement

M.M. and D.M. declare no competing financial interests. D.N. has an independent professional relationship with Examine.com, a competitor of NMCD. The design, execution, analysis, and drafting of this article occurred before the initiation of any connection with Examine.com

Funding Information

No funding was received for this article.

Supplementary Material

Supplementary Table S1

References

Bardia

, Nisly

, Zimmerman

, et al. Use of herbs among adults based on evidence-based indications: Findings from the National Health Interview Survey. Mayo Clin Proc, 2007; 82(5):561–566.

Clarke

, Black

, Stussman

, et al. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Rep, 2015;(79):1–16.

Tindle

, Davis

, Phillips

, et al. Trends in use of complementary and alternative medicine by US adults: 1997–2002. Altern Ther Health Med, 2005; 11(1):42–49.

Millen

, Dodd

, Subar

. Use of vitamin, mineral, nonvitamin, and nonmineral supplements in the United States: The 1987, 1992, and 2000 National Health Interview Survey results. J Am Diet Assoc, 2004; 104(6):942–950; doi: 10.1016/j.jada.2004.03.022

Timbo

, Ross

, McCarthy

, et al. Dietary supplements in a national survey: Prevalence of use and reports of adverse events. J Am Diet Assoc, 2006; 106(12):1966–1974; doi: 10.1016/j.jada.2006.09.002

, Wang

, Tsai

, et al. Trend and pattern of herb and supplement use in the United States: Results from the 2002, 2007, and 2012 National Health Interview Surveys. Evid Based Complement Alternat Med, 2014; 2014:872320; doi: 10.1155/2014/872320

Salmerón-Manzano

, Garrido-Cardenas

, Manzano-Agugliaro

. Worldwide research trends on medicinal plants. IJERPH, 2020; 17(10):3376; doi: 10.3390/ijerph17103376

Sackett

, Rosenberg

WMC

, Gray

JAM

, et al. Evidence based medicine: What it is and what it isn't. 1996. Clin Orthop Relat Res, 2007; 455(7023):3–5; doi: 10.1136/bmj.312.7023.71

Natural medicines. Editorial Principles and Process. Available from: https://naturalmedicines.therapeuticresearch.com/about-us/editorial-principles-and-process.aspx [Last accessed: May 4, 2022 ].

10.

Yacobucci

. Natural medicines. J Med Libr Assoc, 2016; 104(4):371–374; doi: 10.3163/1536-5050.104.4.029

11.

National Center for Health Statistics. 2012 National Health Interview Survey (NHIS) Adult Complementary and Alternative Medicine Public Use File (ALT) Unweighted Frequencies. 2012. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2012/althealt_freq.pdf http://www.webcitation.org/72aFdsloX [Last accessed: July 8, 2022 ].

12.

CDC/National Center for Health Statistics. NHIS −2012 Data Release. 2015. Available from: https://www.cdc.gov/nchs/nhis/nhis_2012_data_release.htm [Last accessed: March 9, 2020 ].

13.

National Center for Health Statistics. National Health Interview Survey: 2019 Questionnaire Redesgin. NHIS Fact Sheet: 2019 Questionnaire Redesgin. Available from: https://www.cdc.gov/nchs/nhis/about_nhis.htm [Last accessed: May 4, 2022 ].

14.

Centers for Disease Control and Prevention. Two Important Laws. Confidentiality Orientation. Available from: https://www.cdc.gov/training/products/ConfidentialityOrientation/page22301.html [Last accessed: May 5, 2022 ].

15.

Johns Hopkins Medicine. Herbal Medicine. Available from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/herbal-medicine [Last accessed: May 5, 2022 ].

16.

American Pharmaceutical Association. In: Proceedings of the American Pharmaceutical Association at the Annual Meeting. Vol 51. American Pharmaceutical Association; 1903.

17.

Scudder

. The American Eclectic Materia Medica and Therapeutics—Digital Collections—National Library of Medicine, 11th ed. J.M. Scudder: Cincinnati; 1891. Available from: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-64230370R-bk [Last accessed: May 5, 2022 ].

18.

Sadtler

. The Dispensatory of the United States of America—Digital Collections—National Library of Medicine. Lippincott: Philadelphia; 1899. Available from: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101539510-bk [Last accessed: May 5, 2022 ].

19.

Stussman

, Bethell

, Gray

, et al. Development of the adult and child complementary medicine questionnaires fielded on the National Health Interview Survey. BMC Complement Altern Med, 2013; 13:328; doi: 10.1186/1472-6882-13-328

20.

Ostrowska

, Skrzydlewska

. The comparison of effect of catechins and green tea extract on oxidative modification of LDL in vitro. Adv Med Sci, 2006; 51:298–303.

21.

Nault

, Beccia

, Kashdan

, et al. Health information discrepancies between internet media and scientific papers reporting on omega-3 supplement research: Comparative analysis. Interact J Med Res, 2018; 7(2):e8981; doi: 10.2196/ijmr.8981

22.

Stellefson

, Paige

, Chaney

, et al. Evolving role of social media in health promotion: Updated responsibilities for health education specialists. Int J Environ Res Public Health, 2020; 17(4):E1153; doi: 10.3390/ijerph17041153

23.

Popović

, Matić

, Bojović

, et al. Ethnobotany and herbal medicine in modern complementary and alternative medicine: An overview of publications in the field of I&C medicine 2001–2013. J Ethnopharmacol, 2016; 181:182–192; doi: 10.1016/j.jep.2016.01.034

24.

WHO. WHO traditional medicine strategy 2014–2023. WHO traditional medicine strategy 2014–2023. 2013. Available from: https://apps.who.int/iris/handle/10665/92455 [Last accessed: May 4, 2022 ].

25.

Food and Drug Administration. FDA 101: Dietary Supplements. Consumer Updates. June 2022. Available from: https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements [Last accessed: January 13, 2022 ].

26.

National Center for Complementary and Integrative Health. Herbs at a Glance. January 2023. Available from: https://www.nccih.nih.gov/health/herbsataglance [Last accessed: January 13, 2023 ].

27.

Gardiner

, Graham

, Legedza

ATR

, et al. Factors associated with herbal therapy use by adults in the United States. Altern Ther Health Med, 2007; 13(2):22–29.

28.

Mehta

, Gardiner

, Phillips

, et al. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Altern Complement Med, 2008; 14(10):1263–1269; doi: 10.1089/acm.2008.0290

29.

Grace

, Higgs

. Interprofessional collaborations in integrative medicine. J Altern Complement Med, 2010; 16(11):1185–1190; doi: 10.1089/acm.2009.0402

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