Ethnobotanical, micrographic and pharmacological features of plant-based weight-loss products sold in naturist stores in Mexico City: the need for better quality control

ARTICLES

Ethnobotanical, micrographic and pharmacological features of plant-based weight-loss products sold in naturist stores in Mexico City: the need for better quality control

Patricia Marta Arenas^I,*; Soledad Molares^II; Abigail Aguilar Contreras^III; Belén Doumecq^I; Florencia Gabrielli^I

^IUniversidad Nacional de La Plata, Facultad de Ciencias Naturales y Museo, Laboratorio de Etnobotánica y Botánica Aplicada, Argentina- Consejo Nacional de Investigaciones Científicas y Técnicas

^IIUniversidad Nacional de la Patagonia San Juan Bosco, Facultad de Ciencias Naturales, Argentina- Consejo Nacional de Investigaciones Científicas y Técnicas

^IIIHerbario Medicinal del Instituto Mexicano del Seguro Social, México

ABSTRACT

The consumption of dietary supplements and herbal mixtures to promote weight loss is a common practice in the West. This study was undertaken in Mexico City, surveying stores selling "natural products" at subway stations. The aims of this paper were as follows: to compile a record of plant products marketed as slimming aids and of retailer perceptions of these products; to review the pharmacological and ethnobotanical literature on the species declared; and to create an optical micrograph of a subset of products to verify the accuracy of the list of component plant species shown on the labels. We applied the techniques of observation, semi-structured interviews and free-listing at the retail stores. Results are presented for the 75 species recorded in the 41 weight-loss products surveyed, showing which plant parts are used, the geographical distribution of the species, pharmacological effects, dosage, route of administration and method of preparation, as well as ethnobotanical information derived from fieldwork. We discuss the values assigned to the species used. Microscopic analyses revealed that many of the plant ingredients declared were absent, highlighting the need for greater quality control and safety of these herbal remedies.

Key words: Urban ethnobotany, dietary supplements, obesity

Introduction

In Mexico City, as in many other large urban conglomerations, traditional markets selling not just food, but also various plant and animal-based therapeutic items, co-exist alongside health food stores known locally as tiendas naturistas. These stores are centers for the sale of packaged natural products, mainly pulverized plants or their derived extracts, and are systematically located in various subway stations, where they are often presented under a relatively similar facade. They offer a similar line of products for sale, including health foods, functional foods, dietary supplements and various herbal remedies used to counteract different conditions.

Our interest is centered on products promoted as weight-loss aids (dietary supplements and herbal remedies), as obesity is currently a concern for a significant sector of society, given its widespread presence throughout the Western world, particularly in large urban centers (Pittler & Ernst 2004; Hasani Ranjbar et al. 2009), heavily influenced by the aesthetic standards spread by the mass media promoting slimness as a benchmark of beauty. For this reason, various practices, such as weight-loss diets, physical exercise and alternative or complementary therapies, exist to counter the effects of obesity, as does the consumption of various products advertized as "natural" (monoherbs, mixtures prepared by a herbalist, teas, dietary supplements, etc.), the majority of which are plant based.

In a previous study on the sale of dietary products in health stores in Mexico City, 40 natural weight-loss products, composed of approximately 75 plant species, were found to be frequently marketed. The most commonly sold products were those whose ingredients included plant species of global medical importance or traditional use (Molares et al. 2012).

Various factors converge in the selection of herbs and the products developed from them, such as the popular belief that herbal remedies are harmless and are more effective than are conventional medicines, the resurgence of philosophies implying a "holistic approach" toward the body and the mind, greater accessibility and the relatively low cost of these herbal products in comparison to those of allopathic medicine (Arenas 2007; Pochettino et al. 2008). In the particular case of weight-loss products, the preference for their consumption seems to be linked to dissatisfaction with the treatments offered by approved health care systems and as a practical alternative to a more natural diet and increased physical exercise (Amariles et al. 2006). Many of the consumers of "natural products" generally resort to self-prescription, without consulting a physician, encouraged by the advice of the salesperson, attracted by the novel packaging of the products and expecting to achieve the desired results within a short timeframe (Bianchi 2003).

Access to various products of natural origin such as these and many others regularly available in fixed or transitory markets or in the rotating markets known as tianguis by part of the Mexican population, as well as the health stores approached in this study, constitute a rich tradition expressing economic, social, cultural, political and religious features (Bellucci 2002; Manzanero-Medina et al. 2009). Martínez Moreno et al. (2006) consider these markets as scenarios key to social processes undertaken everywhere and continuously over time, whereas Bye & Linares (1983) consider them as reflections of the intense relationship existing between plants and populations of different socioeconomic levels. It is thus, as "one of the most striking traces of old Mexico", that markets offer a space conducive to ethnobotanical research, by which we might understand the spatial and temporal distribution of the plants, the flow patterns, the ecological variables and the developmental shifts in the close relationship between the Mexican people and their plants (Bye & Linares 1990). Other more recent concepts define the markets as open and dynamic systems that concentrate and spread empirical knowledge on natural resources, with implications for the recovery and maintenance of popular knowledge, the preservation of plant species and their related uses (Albuquerque et al. 2007; Monteiro et al. 2010).

For their part, naturist stores-understood to be an urban and modern expression of traditional Mexican markets-are centers selling plant products that may be considered non-traditional, given that the interaction between the populace and the stores is of short duration, and the knowledge that sustains their recognition and use is not the fruit of cultural transmission through the generations nor of the sharing of practices (Ladio & Molares 2010; Hurrell et al. 2010, 2011a). Often, it is rather that knowledge of the products has been introduced intentionally, sometimes by means of mass media advertising. In such circumstances, consumers do not have a direct relationship with their production and manufacture, or direct experience with the places where they are sold (Hurrell et al. 2011a). In addition, there is very often a lack of concordance between what is indicated on the label of the bottle and its actual contents, which is usually the result of a lack of standardization, regulations and rigor in the official controls of quality, safety and efficiency (Arenas 2009). Micrographs, together with macroscopic, organoleptic and, in some cases, physicochemical inspections, have facilitated the identification of the plant species used in the making of the products, as well as the detection of possible contaminants, substitutes and adulterants used (WHO 1998; Rivera-Arce et al. 2003; Arenas 2009; Molares & Ladio 2010).

The present work consists of micrographic, ethnobotanical and pharmacological analyses of the plants composing the weight-loss products gathered from health stores located along Line 3 of the Mexico City subway system, listed and published in Molares et al. (2012). The many variables explored in the study cited included the wealth of products specifically recommended for weight loss, their pharmaceutical forms, their retail names, the plant composition stated, the most frequently cited plant species, their presence in traditional Mexican pharmacopoeias, similarities between the products according to their plant composition and average sales rankings in terms of explanatory variables of market preferences.

Materials and methods

The ethnobotanical work was undertaken in Mexico City in June 2010. The study was carried out at stores selling "natural products" located along subway Line 3 in the direction of Ciudad Universitaria-Indios Verdes, a 23-km stretch encompassing 22 naturist stores at 21 stations. Information was obtained via conventional ethnobotanical methodology: observation, participant observation, semi-structured interviews and free list provided by store managers and salespeople (Martin 1995; Alexiades & Sheldon 1996; Albuquerque & Lucena 2004), who were considered "trained" in the sense that they sell the products, know their properties and assist consumers, making recommendations (Pochettino et al. 2008). This new approach studied other features that emerged during the interviews with the salespeople: what the effects to be expected upon consuming the products are; who buys them; at what time of year sales peak; what the instructions for use are; and other information of interest. We also conducted a review of the literature on the pharmacological properties stated for the plant species declared on the labels of the bottles, particularly those related to use for weight loss purposes. The ethnomedicinal uses documented were also investigated, as were the plant parts employed and the geographical distribution of the species considered, for which the authors used the analysis of different sources of information as a basis, with these cited in Table 1.

The samples obtained were analyzed by means of conventional qualitative and quantitative analytical microscopy techniques using optical microscopy and the application of simple histochemical tests (WHO 1998). This presents the micrographs for the species present in the composition of six products marketed as weight-loss aids. The latter were selected for being the most frequently mentioned by respondents and for their greater richness in terms of plant species, whereas one of them-Neo Damiana de California (Arenas AMx6 sample)-was incorporated because its purported slimming effect is relatively novel. The samples acquired were deposited in the Scientific Collections of the Ethnobotany and Applied Botany Laboratory at the Faculty of Natural Sciences and Museum, the National University of La Plata.

Results and discussion

Table 1 lists the 75 plant species declared on the labels of the 41 products analyzed, the pharmacological activity registered in the relevant literature, the documented ethnomedicinal uses, the part of the plant used and its geographical distribution. The products studied take the form of pharmaceutical tablets, capsules, tea bags and powders.

Plant species used in the making of the products and their pharmacological properties

Fifteen plant species possess studied slimming, appetite-suppressant or anorexigenic activity or are effective in slowing gastric drainage: Citrus × aurantium L. (orange group); C. × limon (L.) Osbeck.; C. × aurantium L. (grapefruit group); Cyamopsis tetragonoloba L. (Taub); Cymbopogon citratus (DC.) Stapf; Fucus vesiculosus L.; Fucus sp.; Garci nia spp.; Hoodia gordonii (Masson) Sweet ex Decne.; Ilex paraguariensis A. St. Hil.; Orthosiphon stamineus Benth.; Paullinia cupana Kunth; Arthrospira maxima (Setch. & N. L. Gardner) Geitler ; Arthrospira sp.; and Turnera diffusa Willd. ex Schult. (Tab. 1). There have been no definitive studies assessing the slimming effect of Citrus × aurantium and "guar gum", the resin extracted from Cyamopsis tetra gonoloba (Martínez-Álvarez et al. 2006).

The incorporation of stimulants promoting thermogenesis is also common among the products studied. These include ephedrine, synephrine and caffeine, or rather the presence of plant species rich in these substances, such as guarana (Paullinia cupana) or cola nuts (Cola acuminata (P. Beauv.) Schott & Endl.), all of which are contraindicated for anyone with a heart condition, hypertension or asthma (Martínez-Álvarez et al. 2006; Blanck et al. 2007; Biesemeier & Cummings 2008; Navarro & Ortega 2009). A study conducted in Italy by the Supreme Health Institute and the Italian Pharmacovigilance Agency reports numerous adverse reactions caused by the consumption of supplements based on some of these plants used as weight-loss aids (e.g., Citrus × aurantium, Paullinia cupana and Hoodia spp.). The majority of the reactions were cardiovascular or affected the central nervous system, the skin or the gastrointestinal tract (Vitalone et al. 2008; Navarro & Ortega 2009).

Fucus vesiculosus has been used as a coadjuvant in the treatment of overweight and obesity, basically due to its high iodine content. In sensitive individuals, the same iodine may cause various thyroid conditions, such as hyperthyroidism (Bisset 1994; Phaneuf et al. 1999). Agarwal et al. (2006) reported a clinical case of cardiac arrhythmias and ventricular fibrillation caused by the consumption of herbal slimming medicines containing Fucus spp., dandelion (Taraxacum officinale Webb) and boldo (Peumus boldus Molina). Such products may also be toxic due to the heavy metals concentrated in their thallus (Arenas 2007; 2009; 2010). Furthermore, Arthrospira spp.-due to its phenylalanine content-may reduce appetite, although in 1981 the United States Food and Drug Administration declared it ineffective in promoting weight loss (Martínez-Álvarez et al. 2006). Adulteration, substitution or contamination with other cyanobacteria is also common, which is particularly dangerous due to the existence of toxigenic species (Arenas 2003).

Yerba mate (Ilex paraguariensis), in addition to its traditional consumption in the form of mate (tea) in South America, is also sold in Argentina as a weight-loss aid combined with other plants, such as Turnera diffusa and Paullinia cupana. Although clinical tests have not demonstrated its activity, some studies have yielded encouraging results in terms of weight loss, due to its appetite-modulating effect, which prolongs gastric drainage (Navarro & Ortega 2009). Opinions vary regarding the efficiency of Garcinia gummi-gutta L. (Roxb.) as a weight-loss aid, as some authors maintain that the effect of hydroxycitric acid present in this plant species would be effective in weight loss, whereas others have found that effect to be less than significant in comparison with that of a placebo (Heymsfield et al. 1998; Navarro & Ortega 2009). The lack of clinical studies of Hoodia gordonii in humans precludes any support for its activity (Pittler & Ernst 2004; Navarro & Ortega 2009). Orthosiphon stamineus is actually a diuretic, hence its use in cases of obesity associated with other pathologies. There are no conclusive tests assessing its effectiveness in humans (Moro & Basile 2000; Navarro & Ortega 2009). In general terms, there has been insufficient investigation to encourage the consumption of plants to promote weight loss, except that of Garcinia gummi-gutta and yerba mate, which nevertheless still require further investigation (Pittler & Ernst 2004; Pittler et al. 2005). However, there are 20 plant species that have a diuretic effect: Achillea millefolium L.; Alisma plantago-aquatica L.; Arctostaphylos uva-ursi (L.) Spreng.; Brassica oleracea L.; C. × aurantiifolia (Christm.) Sw.; C. × limon; C. × aurantium (pomelo group); Cymbopogon citra tus; Cynara cardunculus L.; Equisetum arvense L.; Erythraea stricta Schltdl.; Foeniculum vulgare Mill.; Hibiscus sabdariffa L.; Ilex paraguariensis; Orthosiphon stamineus; Peumus boldus; Plantago psyllium L.; Smilax aristolochiifolia Mill.; S. campestris Griseb.; and Taraxacum officinale-17 taxa that function as laxatives: Cyamopsis tetragonoloba; Cymbopogon citratus; Foeniculum vulgare;Fucus vesiculosus; Fucus sp.; Hibiscus sabdariffa; Linum usitatissimum L.; Malus pumila Mill.; Malva sylvestris L.; Malva sp.; Oryza sativa L.; Plantago psyllium; Prunus domestica L.; Rhamnus purshiana DC.; Senna alexandrina Mill.; Tamarindus indica L.; and Triticum aestivum L.-16 taxa that are antihyperglycemic agents: Erythraea stricta; Garcinia spp.; Glycine max (L.) Merr.; Linum usitatissimum; Malva sylvestris; Malva sp.; Opuntia streptacantha Lem.; Opuntia spp./Nopalea spp.; Peumus boldus; Plantago psyllium; Prunus amygdalus Stokes; Silybum marianum (L.) Gaertn.; Arthrospira maxima; Arthrospira sp.; Taraxacum officinale; and Trigonella foenum-graecum L. -19 taxa that are antihyperlipidemic agents (including antihypercholesterolemic agents): Alisma plantago; Amphip terygium adstringens (Schltdl.) Schiede ex Standl.; Camellia sinensis (L.) Kuntze; Cynara cardunculus; Fucus vesiculosus; Garcinia spp.; Glycine max; Linum usitatissimum; Opuntia spp./Nopalea spp.; Orthosiphon stamineus; Oryza sativa; Plantago psyllium; Prunus amygdalus; Rhamnus purshiana; Silybum marianum; Arthrospira maxima; Arthrospira sp.; Trigonella foenum-graecum; and Triticum aestivum-and 30 taxa with a combined effect in the form of two or more effects related to weight loss (Tab. 1). Nevertheless, for the majority of the species mentioned, there have been no scientific studies providing evidence of a link to the effective treatment of obesity (Martínez-Álvarez et al. 2006).

Opinions on green tea, black tea and the variety known as Oolong tea (Camellia sinensis) are divided between those who espouse their effectiveness as slimming aids due to their high content of catechins (Opala et al. 2006) and those who maintain that the number of studies indicating such effectiveness remains insufficient. Opinions also differ regarding the metabolite responsible, whether it is the catechins, the caffeine or the synergy between the two (Kovacs & Mela 2006).

Cynara cardunculus (artichoke), Hibiscus sabdariffa (roselle) and Ilex paraguariensis (yerba mate) may be beneficial in the treatment of hyperlipidemia (Dickel et al. 2007). Artichokes have a purifying effect, as well as reducing cholesterol and contributing to weight loss (Navarro & Ortega 2009). Other ingredients, such as cinnamon (Cinnamomum verum J. Presl.), whose known pharmacological properties have nothing to do with slimming, would only be adding flavor to the product. However, the presence of Marrubium vulgare L.-used as an orexigenic-would have an effect which is exactly the opposite of that expected, given that it is considered to be a good appetite stimulant (aperitif), because it promotes the secretion of saliva, the production of gastric juices and all of the digestive processes (Bradley 2010).

Opuntia streptacantha is reported as an antihyperglycemic agent, explaining why it may be effective in cases of obesity associated with other conditions such as diabetes (Basurto Santos et al. 2006). Thevetia peruviana (Pers.) K. Schum., known as "yellow oleander", is one of the plant species mentioned in the composition of Caps-inn plus (fase 3) and Capslim (both fanciful names for the respective products) but is toxic because it contains glycosides that are cardiotonic. For this reason, the Mexican Federal Commission for Health Oversight ordered its recall from the market (El Universal 2009).

Despite the lack of certainty regarding the pharmacological activity of many of the species considered, together with the antagonistic or adverse effects which may be caused by these products, as well as their or contraindications, they remain a valid alternative for many consumers (Pillitteri et al. 2008). The use of attractive images of muscled or slim individuals is well received by the overweight or obese, who are vulnerable to advertisements of quick solutions and who sometimes ignore or fail to perceive the potential risks that consumption of these products entail (Molares et al. 2012). Of all such products, approximately 80% are mixtures of between 2 and 14 ingredients. It has been shown that consuming three or more species in combination increases the risk of undesirable antagonist effects and of the inhibition of the desired effects (Nascimento et al. 2005).

Plant species employed in the making of the products and their ethnomedicinal properties

The majority (99%) of the species used in slimming products are plants with existing ethnobotanical records, referring to a large variety of medicinal uses (Tab. 1). Of those, 28% have been recorded as weight-loss aids or appetite suppressants. Another group of species have been registered as possible coadjuvants to the treatment of obesity, as diuretics (17%), laxatives (13%), antihyperglycemic agents (13%) and antihyperlipidemic agents (5%), or as products with combined effects (21%). For 15%, there are no ethnobotanical references linking them directly or indirectly with the treatment of overweight.

Similarly, ten of the species mentioned as weight-loss aids through ethnobotanical contributions have been confirmed as such in pharmacological studies, 49 species were investigated and proved to have therapeutic effects coadjuvant to the treatment of obesity and 15 did not have studies of this type related to the uses considered. However, 9 of the 15 species to have been pharmacologically investigated have been revealed in ethnobotanical studies to be slimming aids (Citrus × aurantium;Fucus sp.; F. vesiculosus;Hoodia gordonii;Ilex paraguariensis;Orthosiphon stamineus;Paulli nia cupana, Arthrospira maxima, Arthrospira sp. (Tab. 1).

Microscopic analysis of the species present in a sample of the commercial products

Table 2 presents the results of the microscopic observation, the diagnostic characters found for each of the species listed on the labels as well as the structures or the characters of species not listed on the labels. Generally we found adulterations in the study sample. Also fungal filaments were detected on leaves in the product called Escoba (Arenas AMx1 sample) indicating the deteriorated state of the ingredients. The presence of fungi is often due to storage under conditions of humidity that is higher than that recommended, and its proliferation, as well as that of other microorganisms, may lead to decomposition of the main active plant ingredients and to the generation of substances that, upon ingestion, may lead to toxicity (Nascimento et al. 2005). In addition, for all of the products analyzed, there was a lack of concordance between the composition declared and that actually observed, only 35-58% of the species mentioned on the labels actually being present in the products.

Salesperson recommendations and point of view

The salespeople-employees or sales managers-are mostly women aged between 25 and 45. Although most have no more than 3 or 4 years of experience, there were some salespeople with much more (up to 30 years of) experience. Some also stated that they had used the products themselves, and that it was based on their own experience that they were able recommend the products to customers.

The knowledge possessed by some young salespeople stems from their own interest in informing themselves, which led them to glean such information from the Internet. They also claim to have learned from the accompanying reading material provided by the suppliers. One respondent with a long history in the business claimed to have taken a kind of training course offered by the company and later learned both from customers and from various text-based sources.

In general terms, the respondents cite the harmless nature of the products, stressing that the ingredients are natural ("They don't do any harm because they're herbs", as they claim for Hoodia Slim), unlike chemicals, an assertion which apparently seems aimed at reassuring customers, while simultaneously justifying their prolonged use. Salespeople recommend, for example, that the product be used for 30 days, followed by a period off and then another 30 days of use (e.g., Demograss plus, Caps-inn rosa (fase 1)), 30 days of use (e.g., Alcachofa capsules, clarifying that, in this case, "this does include chemicals", and Adelgasol EEUU Maxislim), another 60 days of use (e.g., Menosgrass), or another 45 days of use (e.g., Demograss, for which "the slimming result is due to various reasons: because it looks after the liver, gets rids of worms and solves digestive problems"). The product known as L-Carnachof Mix also comes with the recommendation to take a 15-day period off before re-starting the treatment, as "that provides the most complete effect". The latter is one of the newest products on the market, and it is said that "it has no laxative effect or other effect on the stomach", "now it's all about artichokes", "now it has artichokes because they burn fat and protect the liver"; another feature is that it is not particularly sought out by men because it is accompanied by a reducing gel for topical use to be applied by massage. In terms of dosage, recommendations vary, from, for example, 1-2 capsules or tablets taken in the morning or evening, and sometimes requiring fasting, 2 doses before each meal or 2 doses three times a day (e.g., Neo Kelp).

In terms of the recommendations made by the salespeople, they repeat the warning concerning laxatives, given that according to the respondents, these "make a person feel bad the next day". This is possibly due to the message widely disseminated in the mass media regarding the harmful consequences of weight loss by sudden dehydration as a consequence of the use of laxatives.

One respondent indicated that "when a consumer experiences secondary effects such as diarrhea and dehydration, they are due to personal intolerance of certain species such as senna, although these effects are required to a certain extent given that the excess fat is eliminated by means of the feces and in the urine". For example, in the case of the Raíz de Nopal tablets containing senna and grapefruit, it states among the ingredients: "Grapefruit burns fat. It also has senna leaves for constipation". Salespeople also sometimes ask customers for personal information in order to suggest the most suitable option, by means of questions such as "How many pounds do you want to lose?", just as they also advise them on the correct way to weigh themselves.

Confusion was also detected regarding certain botanical features on the part of some of the respondents, such as "Espirulina (Arthrospira spp.) is no use on its own because it's like yeast. It's Espirulina plus seaweed that works . . . there's no Espirulina left in Mexico anymore!", which was a response on the source of the raw material. In this case the respondent interviewed specified a difference between Espirulina and Espirulina seaweed. Probably what she meant is that Espirulina has nutritional properties similar to those of yeast. Instead, what you need to lose weight is Espirulina seaweed (better known with this compound name since its appearance on the market). Regarding the absence of Arthrospira nowadays referred to by the respondent, this may be related to the production plant called Sosa Texcoco which was a company who flourished in the 1960s to have since disappeared (Basurto Peña 2009).

In terms of the characteristics of the typical customers buying these products, the respondents claimed that they are both men and women, except in the case of products including lotions or soaps, which are more favored by women. However, information offered by the respondents such as "Tlanchalagua is running very low because it's very popular" may be interpreted as a diagnosis of its environmental availability as well as that of other species which have been exploited for commercial gains, and for which studies investigating these issues will be useful to assess the state of conservation of the diversity of the species used.

Conclusions

The majority of the plants used in the making of products designed as weight-loss aids lack sufficient studies to arrive at conclusive data, with the added aggravating factor of the counter-indications listing the possible adverse effects. Artichoke, Cynara cardunculus, may contribute to weight loss and prickly pear cactus pad, Opuntia strep tacantha, may be effective in obesity linked to diabetes. Thevetia peruviana, known as "yellow oleander" continues to form part of the composition of weight-loss products, despite the Mexican health authorities' ordering of its recall due to its toxic nature. However, certain traditionally used plant species linked to the treatment of overweight and related conditions-whether pharmacologically assessed or not-have been incorporated into industrial products, forming part of the channels of commerce of health stores, becoming visible again to various sectors of the urban population (Hurrell et al. 2011a). This process would definitively attribute more weight to certain ethnobotanical properties than others, influencing and transforming features of their holistic use in the majority of cases (Miles 1998; Molares et al. 2012).

The microscopic analysis carried out allowed us to determine that many of the plant ingredients stated on the labels were absent from the products, that the products contained adulterants and that inappropriate methods of storage were employed, underscoring the urgent need for better quality and safety control of these herbal remedies.

From our analysis of the recommendations provided by the salespeople, we can conclude that it would be desirable for them to receive systematized academic training. In a survey carried out by the Wisconsin School of Medicine, 83% of the consumers surveyed reported not having consulted their family doctor on the consumption of "natural products", and, in the majority of cases, such products were acquired through personal choice. This set of circumstances reveals the primary role that the salespeople play in advising on the selection of herbal remedies (Pfeffer & Kaufer-Horwitz 2001; Arenas 2010).

Despite the negative features encountered, current lifestyles, prevailing aesthetic standards and a lack of time for activities such as physical exercise and sports are likely responsible for public adherence to these new habits of accessing non-traditional therapeutic resources, which may be acquired in health stores found when "passing by" and strategically located on the route that potential consumers are obliged to follow. Meanwhile, traditional markets continue to exist, perhaps oriented toward a more conservative population loyal to its roots.

Acknowledgments

Financial support was provided in the form of research grants from the Red Iberoamericana de Saberes y Prácticas Locales sobre el Entorno Vegetal-Programa Iberoamericano de Ciencia y Tecnología para el Desarrollo (RISAPRET-CYTED, Ibero-American Network of Local Knowledge and Practices related to Plant Ecology-Ibero-American Program for Science and Technology to further Development) and the Argentine Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET, National Council for Scientific and Technical Research). We are grateful to Pablo C. Stampella for providing us with a bibliography on Rutaceae, as well as to the salespeople of the health stores for their participation and cooperation.

Received: 19 October, 2012.

Accepted: 28 June, 2013

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Publication Dates

• Publication in this collection
  02 Sept 2013
• Date of issue
  Sept 2013

History

• Received
  19 Oct 2012
• Accepted
  28 June 2013