For several years, ACSH has been warning consumers that "natural" products such as herbal supplements are neither well regulated nor intrinsically safe. In our publication on potential supplement-drug interactions as well as on this site, we have noted actual and potential problems with such products.
Unfortunately, we now have yet another example of a potentially dangerous natural supplement to bring to the consumer's attention. In the July 15 New England Journal of Medicine, two physicians report1 a possible link between increased risk for stroke in infants of mothers who had taken the herbal supplement blue cohosh. In this case, the mother had taken the supplement as a tea to induce labor and it did do so. But when the baby was a little over one day of age, it had the symptoms of a stroke affecting the right arm. A diagnostic scan was performed and confirmed that there was a blockage in a cerebral (brain) artery.
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Further testing failed to reveal any tendency for accelerated blood clotting (which could account for the blockage) in the baby, or any family history of stroke. But the baby s urine tested positive for a compound called benzoylecgonine which is a product of cocaine metabolism. The bottle of blue cohosh tea the mother had drunk from, as well as an unopened bottle of a different preparation of blue cohosh, also tested positive for this compound.
The authors concluded that either benzoylecgonine is a product of both cocaine and of blue cohosh, or that both herbal preparations were contaminated with cocaine. From the information they had, it was not possible to determine which possibility was true. However, they did cite another case in which the infant of a mother who consumed a large dose of blue cohosh had a heart attack.
According to the late herbal expert Dr. Varro Tyler, blue cohosh is one of the oldest indigenous American plant drugs.2 It is known to have a number of physiological effects such as elevation of blood pressure and stimulation of respiration and intestinal motility, as well as of uterine contractions. Obviously, until more is known about its effects on infants, pregnant women should steer clear of this supplement. Further, considering the lack of information about possible similarities to cocaine, it would be wise to remove it from the natural pharmacopoeias of other consumers as well. This is just another example of the truism that "natural" does not necessarily mean safe.
1Finkel RS, Zarlengo KM. Blue cohosh and perinatal stroke. N Engl J Med 352:302-303.
2Tyler, VE. 1993. The honest herbal. 3rd edition. New York: Pharmaceutical Products Press, Inc. pp.47-48.