Herbal medicines, phytoestrogens and toxicity: risk:benefit considerations

There are several suggested health benefits of phytoestrogens, particularly those found in soy products. Herbal medicines are also widely thought to confer health benefits. Additionally, drugs are prescribed to improve human health, but unlike phytoestrogens and herbal medicines, toxicities are defined in experimental animals and monitored in humans before and after marketing. Knowledge of toxicity is crucial to decrease the risk:benefit ratio; this knowledge defines appropriate conditions for use and strategies for development of safer products. However, our awareness of the toxicity of herbal medicines and phytoestrogen-containing foods is dramatically limited compared to drugs. Some aspects of the toxicity of herbal medicines are briefly reviewed; it is concluded that virtually all of our knowledge is derived from human exposures leading to acute toxicities. Importantly, detection of toxicity is sporadic, and little information is available from prior animal experimentation. Additionally, well-organized monitoring of human populations (as occurs for drugs) is virtually nonexistent. Important toxicities with long latencies are particularly difficult to associate with a causative agent during or even after large scale exposures, as exemplified by tobacco smoking and lung cancer; estrogen replacement therapy and endometrial cancer; diethylstilbestrol and reproductive tract cancers; and fetal alcohol exposure and birth defects. These considerations suggest that much closer study in experimental animals and human populations exposed to phytoestrogen-containing products, and particularly soy-based foods, is necessary. Among human exposures, infant soy formula exposure appears to provide the highest of all phytoestrogen doses, and this occurs during development, often the most sensitive life-stage for induction of toxicity. Large, carefully controlled studies in this exposed infant population are a high priority.