Botanicals: Separating Hype from Fact

Learn the truth about 5 top-selling 5 herbal supplements

By Shelly Smekens, ND, FABNO

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Widely available in grocery stores, big box retailers and online, it’s no wonder that botanicals (more commonly known as herbal supplements) continue to be the best-selling supplements in the world. But it can be difficult to separate hyped up health claims from the true benefits – what works, what doesn’t and why. Let’s examine the 5 top-selling herbal supplements in the United States, separating hype from fact using some current research.

5.  Black Cohosh (Actaea Racemosa)

Black Cohash, also known as Actaea Racemosa, is most often used for symptoms of menopause and premenstrual syndrome.  Originally thought to increase sex hormones such as estrogen, research now indicates that Bloack Cohash may affect neurotransmitters such as serotonin, dopamine and GABA, which provide relief without the adverse effects associated with hormone therapy.  Over a dozen of placebo-controlled trials have shown black cohosh to be an effective tool for reducing hot flashesA 2014 research review by Fritz and colleagues concluded that black cohosh was not harmful to use in breast cancer patients or survivors.  If you take black cohosh, you should mention it to your doctors as there have been isolated reports of elevated liver enzymes.  This herb can also cause headaches in some people.

4.  Green Tea (Camellia sinensis)

Green tea supplements are most often marketed as a weight loss tool or “fat burner” but this popular drink may also be associated with lower risk of some cancers. Epicatechin, a natural flavonoid found in green tea, has been shown in clinical trials to be associated with a decreased risk for early prostate cancer and head and neck cancers.  Some green tea supplements contain caffeine; look for decaffeinated versions to avoid the extra stimulation you get from caffeine.  Please consult a naturopathic provider or your healthcare team before taking green tea extracts as they may interact with certain medications.

3.  Echinacea (Echinacea spp.)

Echinacea, an herbaceous flowering plant found in North America is so popular that several species are listed on the endangered list.  It is primarily taken orally to prevent or treat respiratory infections, such as the common cold.  A 2017 review in the Journal of Evidence Based Complementary Alternative Medicine found Echinacea to be effective for that use.  There is ongoing controversy whether Echinacea is safe to use in people with autoimmune diseases; if you suffer from an autoimmune disease, please consult with your healthcare provider before taking an over-the-counter product containing Echinacea.

2.  Cranberry (Vaccinium macrocarpon)

Once used by Native Americans to treat wounds topically, cranberries have a long history in the diet and medicine of this country.  Now cranberry extracts are most often sold to prevent and treat urinary tract infections.  Research has been mixed for this use.  The most recent research review found cranberry to be effective in reducing the risk of urinary tract infection recurrences in otherwise healthy women.  The average reduction in recurrence was 26%.  Drinking cranberry juice daily also has documented efficacy but often comes with added sugars.

1. Horehound (Marrubium vulgares)

Often found in the form of lozenges, it may be surprising that the modest white flowering Horehound, from the mint family, is consistently the most consumed botanical in the United States.  Most of the consumption of Marrubium is used for soothing sore throats and indigestion but it is also encapsulated and brewed into tea.  Despite its heavy use, clinical trials pertaining to the consumption of white horehound are scanty and much of the research involves mice or livestock.  Of the published research on Horehound, there is some indication that it may be helpful in lowering blood sugar.  Well-designed trials are needed to properly evaluate this herb before recommending medicinal consumption.

There is a vast amount of information and resources about supplements available, which is both a positive and negative. On a positive note, the information is at your fingertips 24/7. On the flipside, with so much information available, who can you turn to for authoritative information? One of the most reliable sources is the National Institutes of Health (NIH), and, in particular, the Office of Dietary Supplements (ODS). There are also non-federally operated Web sites that provide information, generally for a fee, which consumers may find helpful. Two sites that might be helpful include: and

Shelly Smekens is a naturopathic oncology provider at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois who works side-by-side with doctors and other clinicians from several disciplines, all of whom are focused on fighting cancer and helping cancer patients experience a good quality of life. Her training includes supervised clinical practice in oncology, homeopathic, nutritional and botanical medicine, as well as coursework in these modalities. Smekens provides cancer patients with personalized naturopathic recommendations for natural therapies (e.g., vitamins, minerals, herbal medicines) that are safe and appropriate to pair with conventional cancer treatments. She belongs to the American Association of Naturopathic Physicians, the Oncology Association of Naturopathic Physicians and the Illinois Association of Naturopathic Physicians (ILANP), where she also serves on the board.