The Fallacy Behind Herbal Alcoholic Beverages (bitters) Being Marketed As Medicines

The Herbal industry in Ghana has experienced a sudden wind of change in recent times. This is directed towards the production of alcoholic beverages called bitters by various herbal industries at the expense of herbal medicines. These products (Bitters) enjoy heavy media attention, and are marketed as natural products or medicines for sexual dysfunctions, among others. The contents of these advertisement have since misled lots of people especially the youth into developing bad drinking habits.

Herbal bitters are blended herbs, spices, roots, seeds, and bark with a characteristic bitter taste. In the past, they were used as tonics to aid in digestion, particularly of heavy, fatty meals. However, in recent times, two distinctive varieties of bitters exist: Bitters typically formulated into alcoholic beverages, and those produced as tonics (a form of herbal medicines). Medicinal herbal bitters (tonics) contain medicinal plants and spices in a water or alcohol base. These ingredients work together to reduce inflammation, control pain, relax muscles, and improve digestion and elimination. Herbal bitters (tonics) can also be used to treat Arthritis , Poor circulation Nausea, Constipation, Loss of appetite, and Fever. They stimulate all digestive secretions (saliva, hormones and bile, etc), which in turn breaks down food for absorption. Salivation breaks down starches in food as a result of the action of the Amylase enzyme. In the stomach bitters stimulate the secretion of the hormone gastrin which regulates the production of gastric acid. They also increase production of the enzymes pepsin that helps break down protein and intrinsic factor that essential for absorption of Vitamin B12. Bitters (tonics) also act on the pancreas, the liver and gall bladder affecting the release of pancreatic enzyme and bile which aids in digestion of fats and oils. A healthy flow of bile helps rid the liver of waste, and prevents the formation of gallstones and emulsifies lipids. They enhance peristalsis and lubricate the intestine.

The plants or herbs used in herbal bitters (tonics) are initially extracted with alcohol. This gives the best quality extract of the medicinal compounds or constituents present in most herbs or plants (concentrated solutions of active medicinal ingredient) than water. Some plant constituents are deteriorated by heating, and accordingly, it is advantageous that their medicinal constituents be extracted by immersing them into reasonable amount of alcohol. The resultant alcohol concentrated extract is then treated or diluted with suitable solvents like water such that the amount of alcohol present in a dose of the herbal medicine does not have any intoxicating effect. Herbal medicines produced this way are analyzed, their doses, duration of treatment, side effects, and other relevant information certified by the Food and Drugs Authority (FDA). These products (herbal bitters) are then marketed, stocked in pharmacies, licensed chemical and herbal shops after registration. Even with this, the FDA regulations on advertisement clearly emphasize an approval of advertisement content before airing. Media houses involved are also required by the FDA to demand prior to advertising herbal medicines (tonics/bitters); letter showing that the product/medicine has been duly registered and that the registration has not expired, and letter from FDA together with sealed, vetted and approved script showing approval of adverts.

Is this the case with Herbal based alcoholic beverages also referred to as Herbal Bitters?

In theory, bitters are composed of three components: the bittering agent, the flavor and the solvent system. Bittering agents are usually herbs or plants parts such as roots, stem barks, leaves, seeds or dried fruits. They are responsible for the bitter taste, and the feeling of satisfaction of bitters. In Ghana, plants possessing digestive and aphrodisiac properties are mostly used. Flavors give bitters unique taste and smell. They are usually obtained from spices, fruits, and herbs. Several plants parts are mixed by herbal alcoholic industries with the intention of obtaining different flavors and this gives bitters the competitive edge on the market.

Herbal bitters are made with alcohol/ethanol (spirits) as the solvent system and as such are also referred to as herbal based spirits. Spirits or alcohols used are in some cases distilled by the industry involved, and in other cases bought from distilleries in large quantities. The alcohol content of bitters is measured in alcohol by volume (ABV). The ABV of bitters ranges from 28%v/v to 45%v/v. However most herbal alcoholic beverages (bitters) in Ghana have ABV’s or alcohol content of 42%v/v. The effect of alcohol on the body is the main target of manufactured spirits and herbal based spirits. Alcohols on their own enhances appetite by supporting digestion, providing warmth for the body by improving blood circulation/blood flow, leading to a deep sleep, etc. Incorporation of herbs/plants into alcoholic beverages is targeted at obtaining mainly rich flavors and taste although consumers may enjoy some health benefits.

The 1970 liquor licensing Act of Ghana (ACT 331), section 22 describes “Spirits" as akpeteshie, brandy, gin, liqueur, rum, whisky and all other distilled liquors and includes all liquors mixed with spirits and all mixtures, compounds or preparations made with spirits, but does not include alcohols other than ethyl alcohol and potable methyl alcohol and medical or medicinal preparations containing alcohol. The alcohol content in bitters is very high compared to that in medicines (both orthodox and herbal) and therefore bitters are not medicines as proclaimed in various advertisements in the media. They are intoxicating when ingested in large quantities and have no stated dosages (Quantity of active constituents Per dosage unit), approved disease conditions they treat, duration of treatment, stated side effects, storage conditions, etc, and so are not approved for sale in pharmacies, chemical shops or hospitals because they are not medicines.

The wrongful perception and advertisement of Herbal liqueurs or bitters as medicines has led to abuse or binge drinking especially among the youth. Manufacturers of these bitters market their products through the media as aphrodisiacs meant to enhance sexual performances. This is a deception, as long term alcohol use is known to cause impotence in men and infertility in women. This marketing strategy creates what is called the “Placebo effect” as consumers tend to give credits to these products for their sexual performances. Aphrodisiacs are medicines and not alcoholic beverages, meant only for people with sexual dysfunctions including premature ejaculation, arousal difficulties from reduced libido, low sperm count, and orgasmic disorders among others. The use of aphrodisiacs is monitored by qualified Medical experts over a period of time with planned reviews. Individuals who wish to enhance their sexual performances are usually placed on food supplements not aphrodisiacs or alcoholic beverages (bitters). Excessive consumption of Herbal bitters has unpleasant effects on the body just like with every alcoholic beverages. Aside the immediate effects of too much drinking, such as nausea, vomiting, blackouts, memory loss and anxiety. Continuous heavy drinking over longer periods of time results in serious mental health problems, alcoholism or alcohol dependence and permanent brain damage. Alcohol may overtime result in lung infections like pneumonia. Vomits experienced from alcohol intake, may choke if it gets sucked into their lungs thereby resulting in collapsed lungs. Bitters abuse also causes high blood pressure (hypertension), a leading cause of chronic kidney disease. Heavy drinking over longer periods causes arrhythmias (irregular heartbeats) that increases the risk of heart attack, stroke or sudden death. Fat deposits initially develop in the liver then the liver becomes inflamed, resulting in alcoholic hepatitis, a cause of liver failure. Excessive alcohol can permanently scar and damage the liver, resulting in liver cirrhosis and an increased risk of liver cancer (especially in women). Excessive alcohol intake may also cause the stomach to become inflamed (gastritis). This prevents ingested food from being absorbed and increase the risk of cancer. It can also lead to stomach ulcers, and colon cancers. Alcohol abuse interferes with calcium absorption in the body causing bones to become weak and thin. The pancreas becomes inflamed from alcohol abuse, leading to weight loss, fever, and vomiting.

There is therefore the need for the Food and Drugs Authority (FDA) to review all herbal bitters or liqueur advertisements made through the media (both print and electronic) and sanction culprits by way of heavy fines and bans when necessary. There is also a need for the passage of an advertisement bill by government to regulate the contents of adverts in the media to help curb alcohol abuse from consumption of Bitters perceived to be medicinal.

BENTIL EMMANUEL ASARE ADUSEI
BSC HERBAL MEDICINE, KNUST
[email protected]