Dispatches from the UNPA 20th anniversary celebration, Salt Lake City

Is it time to move beyond conventional ‘vs’ natural medicine?

By Elaine Watson

- Last updated on GMT

Dr Low Dog: Focus on the evidence
Dr Low Dog: Focus on the evidence

Related tags: Physician, Alternative medicine, Pharmacology, Depression

While many doctors remain suspicious of ‘natural’ medicine, a growing number now accept that there are compelling alternatives to leading drugs that are supported by just as much scientific evidence, without the nasty side effects, says one leading player in integrative medicine.

Dr Tieraona Low Dog is a clinical associate professor of medicine at the Arizona Center for Integrative Medicine and has a doctor of medicine degree from the University of New Mexico School of Medicine.

Speaking at an event in Salt Lake City organized by the United Natural Products Alliance (UNPA) to celebrate its 20-year anniversary, she admitted that many of her colleagues in the medical profession are still dismissive of ‘alternative’ or even ‘integrative’ medicine.

She also acknowledged that unscrupulous firms peddling snake oil to fight cancer have not helped the dietary supplements industry tackle negative perceptions.

The bottom line: Does it work?

However, a growing number of doctors now recognized that pitting ‘conventional’ versus ‘natural/traditional’ medicine is unhelpful, she said.

It is also illogical given that many conventional drugs are sourced from plants, or are synthetic analogs of compounds found in plants, she said.

Patients, meanwhile, just want products that work, that have strong science behind them, and don't come with costs - in the form of unwelcome side effects - that outweigh the benefits, she said.

“If there is evidence behind it and it is safe, I don’t care if it comes from Pfizer, a supplement manufacturer or the end of an acupuncturist’s needle.

“It’s not a case of either or. Conventional medicine can work alongside traditional medicine and dietary supplements.”

You can’t just send your patient out and say ‘go buy some fish oil’

Indeed, supporters of ‘conventional medicine’ are frequently surprised when presented with the sheer weight of scientific evidence behind ‘natural’ ingredients or ‘traditional’ remedies as chamomile and St John’s Wort, added Low Dog, who only used data from mainstream medical journals in her presentation.

However, patients need careful guidance when selecting dietary supplements, she said.

“You can’t just send your patient out and say go buy some fish oil, or go buy some probiotics. Which fish oil? Which probiotic?”

Always read the small print

Much of her presentation was devoted to a re-appraisal of the evidence behind top-selling prescription drugs, and a warning about how some of these products could deplete levels of critical nutrients such as magnesium.

She also urged delegates to read the small print when confronted by ads suggesting that drug x could reduce the risk of having a heart attack by 50% when in fact the data showed that such assertions were based on small trials in which the absolute risk reduction was minimal.

For example, if two out of 100 people die of a heart attack in a placebo group compared with one out of 100 in active group taking drug X, the drug company will claim that the risk of heart attack is reduced by 50% when taking drug X. But in fact the absolute​ risk reduction is far far smaller, she said.

The point is not that drugs don’t work, simply that doctors should look at the evidence behind them more critically before reaching for their prescription pads, said Low Dog.

Anti-depressants

In particular, the hard evidence behind drugs prescribed in alarming numbers to people experiencing mild or moderate depression is shaky at best, she said.

Indeed, a JAMA review from 2010 concluded that the benefits of anti-depressants such as Xanax for people with mild or moderate depression were “minimal or non-existent​”, she claimed.

Yet 11% of Americans aged over 12 years are now taking anti-depressants, she said.

But how many doctors are aware of a 2008 Cochrane review of 25 studies on St John’s Wort that found it as effective as conventional anti-depressants - without the unpleasant side effects, she asked.

And how many know that a systematic review of 11 RCTs on kava showed it to be superior to placebo for treating anxiety, while a review of clinical trials on saffron showed it was as effective as imipramine and fluoxetine in patients with depression?

Similarly, peer-reviewed studies published in mainstream medical journals repeatedly showed that chamomile was more effective than diazepam for treating sleep problems, yet doctors continued to reach for their prescription pads when patients arrived at their surgery complaining of sleep issues, she added.

Magnesium depletion

Meanwhile, many blood pressure meds (ACE inhibitors) and heartburn meds (proton pump inhibitors) also had worrying side effects in that they depleted the body’s levels of magnesium, ironically a mineral proven to lower blood pressure, she said.

Meanwhile, the lower your level of magnesium, the greater the chance of having elevated levels of C-Reactive Protein (CRP) a key marker of inflammation, she noted.

“Magnesium also makes us more responsive to insulin. So why are we putting people on meds that deplete it?”

Most worryingly, antipsychotic drugs were increasingly being prescribed to young women, when there was hard evidence that they impaired calcium absorption at a time when women needed to build bone mineral density, she added.

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2 comments

MDs have no supplement or herbal training

Posted by MA,

For MDs this is uncharted territory which as been vilified by big pharma, Not even 100 years ago MDs were prescribing compounded medicines which included herbal extracts…. un-patented of course.
Today's medical student barely receives any training on nutrition, never mind supplements, herbs, or other modalities. Any MD that is knowledgeable about theses alternatives had taken it upon themselves to spend their own time becoming educated and practiced in those modalities.
Dr. Low Dog makes an excellent point about adverse effects, over a decade ago properly prescribed drugs killed more that 100K Americans per year. US Conventional healthcare should be looking for all the help it can get: http://silver.neep.wisc.edu/~lakes/iatrogenic.pdf

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Not a Science Issue

Posted by Lightning Rod,

Unfortunately this is not a science issue. This is all about money. You cannot patent natural products, and they have historical use anyway compounding the issue further. That is why people are now putting in new drug applications for dietary supplements, to get some protection. Look at vitamin C for burns .... And natural products are complex medicines, not single compound magic bullets. The FDA is not set up to handle complex drugs that cannot be patented. So expect more of the same as pharma continues to control the FDA. And remember the doctor gets new golf clubs and a sweet trip to an island somewhere to use them when they reach for that prescription pad....

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