Beware of supposedly herbal or natural products

You may have come across herbal or natural products marketed to help with weight loss, pain relief or sexual enhancement. Such products may come in the form of beverages, candy or capsules. Have you wondered if their herbal or natural claims are genuine?

The Health Sciences Authority (HSA) regularly samples and tests some of these products as part of market surveillance. Contrary to the claims, some are not purely herbal or natural. In fact, some of these contained various undeclared synthetic medicinal substances that can be harmful.

Often, the undeclared synthetic medicinal substances are added intentionally and sometimes in high amounts, to achieve quick effects and deceive consumers into thinking that these products work wonders. These products also may have been manufactured under poor quality control or unhygienic conditions, resulting in product quality lapses such as contamination with microorganisms or heavy metals. Consuming these products can potentially lead to serious adverse effects, overdosing or poisoning, and even death in some cases.

These fraudulent products may be sold online, on social media, by street peddlers or by word-of-mouth recommendations. Not only do consumers not get what they paid for in the first place, they put their health at risk. There is also no way of keeping track of these online dealers, or contacting them should any problem arise. Consumers would have no recourse should there be any serious health consequences.

Tips for consumers when deciding to purchase and/or consume certain products that are supposedly herbal or natural:

1. Know the risks – you could seriously damage your health and lose money.

2. Stay safe – Follow the A-B-C-D steps to check that you are not endangering your health:

• Avoid making purchases from suspicious sources. Find out who you are buying from and what you are buying. As a general guideline, buy from reputable sources such as a pharmacy or established retail store/chain. When purchasing from e-commerce platforms or over the internet, consumers are strongly encouraged to purchase from businesses with established retail presence.

• Beware of deals that sound too attractive. If the price is much lower than expected, or product information sounds too good to be true, it probably is.

• Check the claims. Not all advertised claims are true and they can be exaggerated or over-promise. Do not gamble with your health.

• Discuss with your doctor or pharmacist on the suitability of a product if you are unsure.

Here are some examples of products which HSA has tested to contain undeclared ingredients, and which caused serious adverse effects in consumers:

"Ubat Angin Tulang (松筋风湿透骨丸)"

“Ubat Angin Tulang” was touted to strengthen muscles and help with pain management. A woman in her 60s took the product for about three months for her knee pain and rapidly gained 10 kg. She also developed high blood pressure. The product’s label stated only herbal ingredients, including ginseng and cordyceps. However, when HSA tested the product, it was found to contain three potent medicinal ingredients, namely dexamethasone (potent steroid), furosemide (diuretic/water pill) and chlorpheniramine (antihistamine). These strong medicinal substances can cause serious adverse effects when used without supervision by a doctor. The steroid in the product could have caused the woman’s rapid weight gain and high blood pressure.

“Tianma Duzhong Shujing Wan (天麻杜仲舒筋丸 [山花商标])”

In another case, an elderly man in his 80s experienced dizziness and a drop in blood pressure after consuming the product for his knee pain for about one year. He had obtained the product from his relative who had purchased it from Malaysia. He was diagnosed with adrenal insufficiency, a serious medical condition. “Tianma Duzhong Shujing Wan” was labelled as containing only herbs, including ginseng. However, HSA’s analysis detected five potent medicinal ingredients namely, dexamethasone and prednisolone (potent steroids), diclofenac (anti-inflammatory painkiller), furosemide, and chlorpheniramine.

“IM SO am” and “IM TOX pm”

A woman had severe tremors, insomnia, light-headedness and almost fainted twice after consuming “IM SO am” and “IM TOX pm”. Both products were marketed to be taken together for slimming purposes and were labelled to contain food and botanical extracts to “promote better body balance”. However, HSA’s analysis revealed that “IM SO am” contained the banned substance, sibutramine, and “IM TOX pm” contained sennosides (a laxative).

"AK-II Phenomenal King"

"AK-II Phenomenal King" was marketed as a natural product for sexual enhancement. The product claimed to be “devoid of animal element, devoid of stimulants, devoid of side effects”. However, in contrast to its claims, it contained over 60 times the usual dose of tadalafil, a prescription medicine used to treat erectile dysfunction that should only be given under medical supervision. The inappropriate use of tadalafil is dangerous and can increase the risk of serious adverse effects, including heart attacks, stroke, palpitations, irregular heart rate and priapism (painful and exceedingly long erections). Tadalafil can also pose serious risks to certain individuals, including those with heart-related problems and those who are on certain heart medications.

"Traditional Herbs Preparation XPE"

"Traditional Herbs Preparation XPE" had listed a variety of natural herbs as ingredients and was marketed for general health. However, a woman in her 60s who had been taking the product for over nine months to alleviate her joint pain found her pain worsening when she stopped taking it or reduced the dose. HSA tested the product and detected six medicinal ingredients: dexamethasone (a steroid), chlorpheniramine (an antihistamine), ibuprofen (a non-steroidal anti-inflammatory drug), lovastatin (a cholesterol-lowering medicine), chloramphenicol and tetracycline (both antibiotics). Long-term unsupervised use of steroids such as dexamethasone can cause increased blood glucose levels (which may lead to diabetes), Cushing’s syndrome (characterised by a round face or "moon face" appearance, and upper body obesity with thin limbs), and other serious adverse effects.

"BB Body" and Anyang Herbal Products

Several weight loss products that HSA tested were found to contain sibutramine¹ or excessive levels of it, but their packaging or labels did not state this. Instead, they claimed to contain natural ingredients and to be free of side effects. Certain products even contained painkillers or laxatives that were not declared.

"BB Body" was marketed as having “no side effects” and being able to deliver fast weight loss within days. However, a woman in her 50s who consumed the product for 3 months developed extremely fast heart rate (ventricular tachycardia), and loss of consciousness. She had to be resuscitated to save her life. As a result, she suffered severe heart failure, and was implanted with a defibrillator (device to regulate heart rhythm). She also requires long-term heart failure medications. She had purchased "BB Body" from an online seller based in Malaysia after coming across an Instagram post of the product. Tests by HSA found that the product contained the banned substance, sibutramine which can cause serious side effects.

"Anyang Herbal Blue" and "Anyang Herbal Red" were labelled as containing “100% natural ingredients” and sold online and through direct selling. "Anyang Herbal Blue" was also touted to have “no side effects”. Contrary to what was on the labels, very high levels of sibutramine were detected in the products. Consumers who took either product based on their labelled dosing instructions would have taken as high as eight times the maximum dosage of sibutramine per day. "Anyang Herbal Red" was also tested to contain undeclared diclofenac (a painkiller) and phenolphthalein (a laxative). A female consumer in her late 20s who took "Anyang Herbal Blue" suffered heart palpitations, nausea, trembling of hands and legs, sweating, insomnia and illusions.

Consumers should therefore be very wary of products that are touted to be purely herbal or natural and with “no side effects”. Such products may also claim to be fast acting and carry testimonials which cannot be verified.

¹ Sibutramine was previously available as a prescription-only weight loss drug but has been withdrawn from Singapore since 2010, due to an increased risk of heart attacks and strokes. Other serious adverse effects associated with the use of sibutramine include high blood pressure, irregular heartbeats, hallucinations and mood swings.