South Africa's vitamin, supplement and alternative medicine industry is worth an estimated R2-billion annually, with thousands of new products going on sale each year. We import them, we manufacture them locally and, according to industry experts, we're constantly clamouring for more.

The industry is, as yet, unregulated (manufacturers are at loggerheads with the Medicines Control Council over elements of proposed legislation), which leaves us a little at sea in terms of what we buy, and how we use many alternatives. But there is no doubt that they've more than earned their place on our shelves, and, as more research is carried out, doctors formerly opposed to anything considered alternative are even recommending them.

Two supplements currently making waves are the intriguingly named black cohosh, and glucosamine - one a remedy for menopause, the second for joint support.

Black cohosh is primarily prescribed as an alternative to HRT, but is also credited with relieving menstrual pain. It comes from the root of a plant used by American Indians for various ailments, but the jury's still out as far as many Western doctors are concerned - they want more research before they're convinced it works.

It's available in tablet or capsule form, as a liquid or as dried root for making tea.

Brent Murphy, a consultant pharmacist specialising in herbal and nutritional medicine, credits black cohosh with treating almost all symptoms of menopause. These may include insomnia, hot flushes, depression and hair loss. During menopause, oestrogen levels drop. Phytoestrogens like black cohosh, he says, mimic the effects of oestrogen, stimulating the body's cells to function as normal. "Conventional and synthetic HRT can increase your risk of heart disease, stroke and cancer by 25-75%," says Murphy, and studies have shown increased risks for breast cancer.

But Dr Femi Olarogun, a gynaecologist and consultant in re­productive medicine at the Department of Obstetrics and Gynaecology at Groote Schuur Hospital, says: "We don't have enough scientific data to prescribe black cohosh, or to suggest that it's completely harmless. With HRT, we know what the side effects are, and can warn the patient about them." And scientific trials have shown that HRT does protect against osteoporosis, which black cohosh doesn't.

Because trials conducted on black cohosh have been of insufficient duration, some manufacturers recommend its use for no more than six months. Those side effects noted include weight gain, dizziness and rash, and some studies suggest it may be linked to liver damage. It is also not recommended for women who are pregnant or breastfeeding because, says Murphy, the appropriate research has yet to be conducted.

Black cohosh is known to react with other medication (like paracetamol), so if you're on medication and taking supple­­ments, scrutinise the labels to ensure black cohosh isn't included.

What about Glucosamine?
Glucosamine is produced naturally in the body, where it is used to make cartilage. In supplement form, its biggest plus is that it doesn't only treat the symptoms, but can actually slow the progress of joint diseases caused by wear and tear, especially osteoarthritis and injury.

Exogenous glucosamine in tablet or capsule form is being manufactured as a supplement to the glucosamine found in our joints. It is also available in a cream, but rheumatologist Dr David Gotlieb says this is "a scam", because it can't be absorbed.

You may find a glucosamine supplement combined with a substance called chondroitin - another naturally occurring substance which can protect the joints from wear and tear. For best results, says Susan Clark, author of What Really Works in Natural Health (Random House), look for a supplement that combines glucosamine with chondroitin and collagen.

Recent scientific studies suggest that glucosamine is more effective in the prevention of osteoarthritis if combined with methylsulfonylmethane (MSM) - a naturally occurring organic sulphur which plays a key role in tissue healing.

In supplement form, glucosamine is produced from shellfish, and so should not be taken by anyone allergic to shellfish; and the American Dietetic Association also warns against its controversial effects on blood glucose control - a possible red flag for diabetics.

By Nomfundo Mbaba Tshabalala