DOING NATURAL

Last week a nice lady in her 40s who has high cholesterol sent me an email to inform me that after doing some reading on the Internet that she has grave concerns about the “liver” problems associated with these cholesterol medications and that she was going to stop taking it and wanted my opinion on that.

I used to do “battle” with patients who had such qualms about prescription medications, either because of what they read or what Aunt Tilly told them.  But I’ve long resigned to the fact that peace of mind, and confidence about the health care that one receives is more important than trying to convert them from the unfounded fears they have about (some) prescription medication and then have them to continue in lost confidence with the medication or care.

Most people are reasonable and are amenable to most treatment plans once the rationale is explained to them, often in detail.   But some continue to harbor resistant unfounded fears no matter who or what they hear.  Like the nice lady.
She said she instead decided to use some natural “stuff” from GNC that controls the cholesterol.  She didn’t name the “stuff” but asked me if that was an okay thing to do.  She expressed confidence in the product because it was “natural.”

Since I didn’t know what ingredients were in the product I told her I couldn’t form an opinion.  But I thought her logic in taking it was a little weird in that she, like many like her, had decided to abandon a medication that has been around and used for over three decades and, before that, had gone through rigorous scientific testing, and instead she has opted to put into her body this “natural” product, about which she knows nothing with respect to its safety or long term use.  She couldn’t say what this product’s effects on her liver, kidney, or heart rhythm would be or if that risk long term was accumulative.

Anyway, in a vulnerable moment, or perhaps an aggravated one, I broke my rule and thought that it might be helpful to provide her insight on the “natural” is better than “tested” approach.  Back in the 80s there was this herb fad which, as the years have gone by, has faded from fanaticism to a more selective approach.  And since then there’s been a wealth of individual and collective experience with “natural” products, including scientific testing on many popular herbs and “natural” products.

Of the many herbs on the market, only the use of cranberry for the prevention of recurrent urinary tract infections in women is supported by some scientific evidence.  The efficacy of other natural herbs has not been proven when subjected to sound scientific study.  The benefits of St John’s wort for short term treatment of depression is still debated.  There is questionable evidence for ginseng, which is often used to improve physical and cognitive performance.  Ginkgo biloba is marketed to improve memory and cognitive performance but there is no consistent scientific evidence to support this use.  Same goes for garlic (to lower cholesterol), ginger (to treat nausea), and soy (for control of menopausal symptoms).

Not everyone has good results from taking a natural product that was helpful for someone else.  Same applies to prescription meds.  Herbal medication can mistakenly be perceived as safe because they are natural products.  But they may produce negative effects such as allergic reactions, rashes, asthma, headaches, dizziness, agitation, dry mouth, seizures, fatigue, tachycardia, nausea, vomiting, and diarrhea.  Cases of hepatotoxicity (liver damage) were reported for kava kava and life-threatening anaphylactic reactions have been reported for most herbal medications.  Moreover, it’s not recommended that one take herbal medications if you are pregnant and breastfeeding, and they shouldn’t be given to children.

Herbs can also modify the effect of conventional medications.  For example, cranberry and ginkgo biloba should be used cautiously by people who take blood-thinning medications (warfarin, aspirin) because of an increased risk of bleeding.  St John’s wort interferes with the effect of many mediations (birth control pills, antidepressants, and anti-HIV medications.  And the active ingredients of many herbal medications are not readily known, and contamination has been reported.

Of course, many plants are a primary source of substances that have been shown to be therapeutic.  The foxglove plant, for example, provides the active ingredient, digitalis, now synthesized, that treats congestive heart failure.  And there are many other examples.  The point is not to necessarily abandon or ignore, like the nice lady, that which has been tried and proven, for that which is unknown, without giving it some forethought.

If you use herbs or “natural” supplements, be aware.  Not all “natural” things are without potential for safety issues.
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Stay safe.  Stay healthy.