Skip to main content
SpringerLink
Log in

Herbal Products and Dietary Supplements: A Cross-Sectional Survey of Use, Attitudes, and Knowledge Among the Lebanese Population

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

There has been a marked increase in use of herbal products and dietary supplements (HP/DS) in many developed and developing countries. However, data about consumption patterns and awareness about these products in the Lebanese population is scarce. The present study aimed to examine the determinants of HP/DS use in Lebanese adults, identify potential interactions and safety concerns and assess the knowledge and attitudes of consumers towards the efficacy and safety of these products. A face-to-face, 28-item survey was administered to Lebanese adults (n = 726) in community pharmacies across the country. Thirty-five percent of participants reported to be currently consuming at least one HP/DS including 23 % who were consuming vitamins and/or mineral supplements and 18 % consuming herbal products. Significant safety concerns were identified among consumers in the form of disease–supplement, drug–supplement as well as supplement–supplement interactions. Logistic multivariate regression analysis indicated that use of supplements was positively associated with the female gender and increasing age. The majority of respondents falsely believed that HP/DS pose no risk to the general population and that they must be safe to be sold in Lebanon. Moreover, most participants were consuming these products based on recommendations from friends or relatives rather than from healthcare professionals. Substantial misconceptions about HP/DS exist among Lebanese adults, indicating a need for consumers’ education from professional and reliable sources on the efficacy and safety of such products.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. World Health Organization. (2005). National policy on traditional medicine and regulation of herbal medicines: Report of a WHO global survey.

  2. US Food and Drug Administration. Dietary supplement health and education act of 1994.

  3. Department of Health and Human Services (DHHS), Office of the Inspector General. (2003). Dietary supplement labels: key elements. Report OEI-01-01-00120.

  4. Nutrition Business Journal. NBJ’s Supplement Business Report 2015. Penton Media, Inc., 2015.

  5. Dietary Supplements: What you need to know. (2011). US Department of Health and Human Services, Office of Dietary Supplements. National Institutes of Health.

  6. Chen, X. W., S Serag, E., B Sneed, K., et al. (2011). Clinical herbal interactions with conventional drugs: From molecules to maladies. Current Medicinal Chemistry, 18(31), 4836–4850.

    Article  CAS  PubMed  Google Scholar 

  7. Hartshorn, E. A., Lomaestro, B. M., & Bailie, G. R. (1991). Quinolone-cation interactions: A review. Annals of Pharmacotherapy, 25(11), 1249–1258.

    Google Scholar 

  8. Altundag, O., Altundag, K., Silay, Y. S., Gunduz, M., Demircan, K., & Gullu, I. (2004). Calcium and vitamin D supplementation during bisphosphonate administration may increase osteoclastic activity in patients with bone metastasis. Medical Hypotheses, 63(6), 1010–1013.

    Article  CAS  PubMed  Google Scholar 

  9. Bjelakovic, G., Nikolova, D., Gluud, L. L., Simonetti, R. G., & Gluud, C. (2012). Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane: The Cochrane Library.

    Book  Google Scholar 

  10. Marinac, J. S., Buchinger, C. L., Godfrey, L. A., Wooten, J. M., Sun, C., & Willsie, S. K. (2007). Herbal products and dietary supplements: A survey of use, attitudes, and knowledge among older adults. The Journal of the American Osteopathic Association, 107(1), 13–23.

    PubMed  Google Scholar 

  11. Kennedy, J. (2005). Herb and supplement use in the US adult population. Clinical Therapeutics, 27(11), 1847–1858.

    Article  PubMed  Google Scholar 

  12. Samojlik, I., Mijatović, V., Gavarić, N., Krstin, S., & Božin, B. (2013). Consumers’ attitude towards the use and safety of herbal medicines and herbal dietary supplements in Serbia. International Journal of Clinical Pharmacy, 35(5), 835–840.

    Article  CAS  PubMed  Google Scholar 

  13. AlBedah, A. M., Khalil, M., Elolemy, A. T., et al. (2013). The use of and out-of-pocket spending on complementary and alternative medicine in Qassim province, Saudi Arabia. Annals of Saudi Medicine, 33(3), 282–289.

    PubMed  Google Scholar 

  14. Awad, A., & Al-Shaye, D. (2014). Public awareness, patterns of use and attitudes toward natural health products in Kuwait: A cross-sectional survey. BMC Complementary and Alternative Medicine, 14(1), 105.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Naja, F., Mousa, D., Alameddine, M., Shoaib, H., Itani, L., & Mourad, Y. (2014). Prevalence and correlates of complementary and alternative medicine use among diabetic patients in Beirut, Lebanon: A cross-sectional study. BMC Complementary and Alternative Medicine, 14(1), 185.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Alaaeddine, N., Okais, J., Ballane, L., & Baddoura, R. M. (2012). Use of complementary and alternative therapy among patients with rheumatoid arthritis and osteoarthritis. Journal of Clinical Nursing, 21(21–22), 3198–3204.

    Article  PubMed  Google Scholar 

  17. Naja, F., Alameddine, M., Itani, L., Shoaib, H., Hariri, D., & Talhouk, S. (2015). The use of complementary and alternative medicine among lebanese adults: Results from a National Survey. Evidence-Based Complementary and Alternative Medicine.

  18. Ernst, E., & Hung, S. K. (2011). Great expectations. The Patient: Patient-Centered Outcomes Research, 4(2), 89–101.

    Article  CAS  Google Scholar 

  19. Stickel, F., & Shouval, D. (2015). Hepatotoxicity of herbal and dietary supplements: An update. Archives of Toxicology, 89(6), 851–865.

    Article  CAS  PubMed  Google Scholar 

  20. Foote, J. A., Murphy, S. P., Wilkens, L. R., Hankin, J. H., Henderson, B. E., & Kolonel, L. N. (2003). Factors associated with dietary supplement use among healthy adults of five ethnicities the Multiethnic Cohort Study. American Journal of Epidemiology, 157(10), 888–897.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Block, G., Sinha, R., & Gridley, G. (1994). Collection of dietary-supplement data and implications for analysis. The American Journal of Clinical Nutrition, 59(1), 232S–239S.

    CAS  PubMed  Google Scholar 

  22. Slesinski, M. J., SUBAR, A., & Kahle, L. L. (1995). Trends in use of vitamin and mineral supplements in the United States: The 1987 and 1992 National Health Interview Surveys. Journal of the American Dietetic Association, 95(8), 921–923.

    Article  CAS  PubMed  Google Scholar 

  23. Slesinski, M. J., Subar, A. F., & Kahle, L. L. (1996). Dietary intake of fat, fiber and other nutrients is related to the use of vitamin and mineral supplements in the United States: the 1992 National Health Interview Survey. The Journal of Nutrition, 126(12), 3001.

    CAS  PubMed  Google Scholar 

  24. Guallar, E., Stranges, S., Mulrow, C., Appel, L. J., & Miller, E. R. (2013). Enough is enough: Stop wasting money on vitamin and mineral supplements. Annals of Internal Medicine, 159(12), 850–851.

    Article  PubMed  Google Scholar 

  25. Krauss, R. M., Eckel, R. H., Howard, B., et al. (2000). AHA dietary guidelines revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation, 102(18), 2284–2299.

    Article  CAS  PubMed  Google Scholar 

  26. Planta, M., Gundersen, B., & Petitt, J. C. (2000). Prevalence of the use of herbal products in a low-income population. Family Medicine, 32(4), 252–257.

    CAS  PubMed  Google Scholar 

  27. Johnson, E. M., Wootton, J. C., Kimzey, R., et al. (2000). Use of herbal therapies by adults seen in an ambulatory care research setting: An exploratory survey. The Journal of Alternative and Complementary Medicine, 6(5), 429–435.

    Article  CAS  PubMed  Google Scholar 

  28. Eisenberg, D. M., Davis, R. B., Ettner, S. L., et al. (1998). Trends in alternative medicine use in the United States, 1990–1997: Results of a follow-up national survey. JAMA, 280(18), 1569–1575.

    Article  CAS  PubMed  Google Scholar 

  29. Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey. JAMA, 287(3), 337–344.

    Article  PubMed  Google Scholar 

  30. Knudsen, J. F., & Sokol, G. H. (2008). Potential Glucosamine‐Warfarin Interaction Resulting in Increased International Normalized Ratio: Case Report and Review of the Literature and MedWatch Database. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 28(4), 540–548.

    Article  CAS  Google Scholar 

  31. Izzo, A. A., & Ernst, E. (2001). Interactions between herbal medicines and prescribed drugs. Drugs, 61(15), 2163–2175.

    Article  CAS  PubMed  Google Scholar 

  32. Smith, J. D., & Clinard, V. B. (2014). Natural products for the management of type 2 diabetes mellitus and comorbid conditions. Journal of the American Pharmacists Association, 54(5), e304–e321.

    Article  PubMed  Google Scholar 

  33. Pines, A. M., & Zaidman, N. (2003). Israeli Jews and Arabs similarities and differences in the utilization of social support. Journal of Cross-Cultural Psychology, 34(4), 465–480.

    Article  Google Scholar 

  34. Frisk, P., Kälvemark-Sporrong, S., & Wettermark, B. (2014). Selection bias in pharmacy-based patient surveys. Pharmacoepidemiology and Drug Safety, 23(2), 128–139.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge Ms. Marya Hanna and Ms. Maria-Elena hakim for their contribution in interviewing participants.

Authors’ Contributions

G.K. and N.Z. conceived the study, and participated in its design and coordination. N.Z., G.K. and W.R. carried out the data collection. N.Z. performed the statistical analysis. The manuscript was drafted by G.K. and N.Z. and reviewed by W.R.

Author information

Authors and Affiliations

  1. School of Pharmacy, Lebanese American University, PO Box 36, Byblos, Lebanon

    Ghada El Khoury & Wijdan Ramadan

  2. Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, PO Box 36, Byblos, Lebanon

    Nadine Zeeni

Authors
  1. Ghada El Khoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wijdan Ramadan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadine Zeeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadine Zeeni.

Ethics declarations

Conflict of interest

All authors declare of no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Khoury, G., Ramadan, W. & Zeeni, N. Herbal Products and Dietary Supplements: A Cross-Sectional Survey of Use, Attitudes, and Knowledge Among the Lebanese Population. J Community Health 41, 566–573 (2016). https://doi.org/10.1007/s10900-015-0131-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-015-0131-0

Keywords

Search

Navigation