Sunday, January 22, 2012

A Patient with Natural Supplements 3

In the last couple of posts, I recounted having to spend about 2 hours looking up all of the ingredients of all of the supplements a patient of mine was taking, at the prescription of her chiropractor.

This post is about my anger.

Why aren’t supplement ingredients on the label of the product?

How come most prescription products come with a sheet of paper the size of a tablecloth, folded 1024 times so it ends up the size of a stamp, completely covered with tiny print that is required bylaw to mention every rare adverse event that happened to subjects during a clinical trial?  Because it’s required.

If the product is effective as a drug, and is used as a drug, why aren’t there clinical trials? 

Why do I need to spend 2 hours looking this stuff up?

Why didn’t the other guy review with the patient all the potential side effects, the risks of interactions, the risks of hypotension and collapse, of bleeding spontaneously, of increased menstrual cramps, flushing, lactating, breast pain, odd body odor, stomach pain, gas pain, diarrhea, allergic reactions, rashes, itches?

Why is it that I have to reassure myself that the undocumented sourcing of slaughterhouse discards of adrenal and thymus glands and testicles from many animals of several species won’t require disclosure of the risk of Bovine Spongiform Encephalopathy—Mad Cow Disease?

Why should I have to worry about the products claiming to be better and natural sources of vitamins because they are derived from algae?  The fact that algae are being proposed to de-contaminate toxic heavy-metal superfund sites, because they so selectively accumulate this kind of poison, shouldn’t be a problem for people taking algae every day, right? 

If I prescribe a medication, and there’s a problem interaction with one of the supplements, who will rush to help the patient?  Who will answer the phone on the weekend, or at night?  Who will spend the time to figure it out?  Who will be blamed?

And it did, indeed, occur to me after hours of research into these products and their ingredients, that I looked up what was on the label.  There is no regulation requiring that what is on the label is exactly what is in the pill, or if it’s fresh, or if it’s not contaminated, infected, or accurate. 

Are you really, really sure you want your kids taking this stuff?  Is it really better than whatever you consider a drug?  Did the person at the health food store tell you about all the side effects and interactions?  Did that nice woman in your mom’s group?

Sunday, January 15, 2012

A Patient with Natural Supplements 2

marigold1When I first reported the prevalence of Calendula in natural products recommended for skin conditions, I pointed out that calendula was a derivative of marigold flowers.  Marigold is a sibling to ragweed, the most common allergen in North America.  So it seemed particularly shocking to me that the natural products industry has somehow targeted all those kids with eczema to get this product that will often make their skin much worse, even if they avoid the emergency room for the asthma attack.

I noticed that my patient had some nasal allergies.  I didn’t make anything of it—I have some of these too.  But I spent a couple of hours making sure that the medication I was prescribing didn’t have some kind of interaction with the 8 nutritional supplements recommended by her chiropractor.  I wasn’t too concerned about the vitamins, whether they came from algae or a Swiss pharmaceutical company.  Deep down on the list of one of the products—mostly vitamins and minerals in this one—was a quick mention in the ‘other ingredients’ section:  barley grass.  I wondered if it could be triggering her grass allergies in the middle of winter.

And there was another product with Globe Artichoke as an ingredient.  It’s in the same flower family as marigolds and ragweed.

Yet another product contained Milk Thistle.  It’s in the same plant family as, sure enough, marigolds and ragweed and artichoke.

But it probably didn’t help that buried in the long list of ingredients in another product was dandelion. Lots of people are allergic to that, too. She wasn’t taking antibiotics, so I wasn’t worried about the dandelion lowering the levels of antibiotics in her blood.

She was taking a product I often recommend:  Fenugreek.  It’s a common spice in Indian recipes, but that’s not the way I prescribe it.  I use it with new mothers struggling to develop their milk supply.  Not with all, and not with whatever dose they want.  I write down for them exactly how many milligrams, how many times a day, what they should expect, and what side effects they should look out for.  Just like any medication I prescribe. 

Because I was very experienced with the use and dosage of this product, I don’t expect—though that doesn’t mean it’s not possible—that this teenage girl will start leaking in an embarrassing way during 2nd-period geometry.  Should I warn her that it can increase uterine cramping? 

I found out that many of the product ingredients interfere with blood clotting.  Some have effects on blood pressure.

I’m happy to admit that somebody with high blood pressure might do quite well on Reishi Mushroom.  Maybe better than on conventional drugs.  But it’s still a drug.  Some studies show that it decreases platelet activity.  That’s generally a good thing in heart-disease patients.  And anything that lowers your blood pressure increases the risk of fainting, sometimes not at the most convenient moment. 

What is so annoying is the obvious elephant in this room.  It’s a supplement when I try to supplement my diet with some extra fruit and vegetables.  But these are drugs.

The natural medicine folks want to have it both ways.  If the plant products actually work medically, they are better because they work ‘naturally.’  But if they work medically, and do all the things claimed—like serious changes to bleeding, blood pressure, or the immune system—why aren’t they drugs?  If they don’t work medically, why are they recommended? 

Monday, January 9, 2012

A Patient with Natural Supplements 1

Late last week, I met a new patient.  A delightful teenager, she was interesting and engaging.  She was insightful and open, and I agreed with part of the diagnosis she came in with.  I would be prescribing some medication for her.

I asked some typical new-prescription questions.  Was she taking any medications?  Did she have any allergies?  No, and no.

It was the first time I met her, so I asked about her stuffy nose that she kept rubbing.  Well, she did have those kind of allergies.  As we went through some of her medical issues, she revealed some typical teenage-girl symptoms.  I asked if she has tried to do anything about these, does she take ibuprofen, and so on.  She said that her mom took her to the chiropractor, and she takes some supplements that were recommended.

Which supplement?  She didn’t know.  She said it was 8. 

“Eight ingredients?” I asked.

“No,” she said.  “Eight separate bottles.”

“What do they do?”

“I don’t know,” she said, earnestly.  At my request, a parent emailed me the list.

Don’t expect a complete horror story—this isn’t one.  Most of the products were basically vitamins.  Calcium from seashells, and B-vitamins from Blue-green algae.  There were a couple of surprises, and some insight from my research.

Funny thing about algae:  it concentrates what is in the water it lives in.  So it is a concentrated form of protein and vitamins.  But it is often found with high levels of heavy metals.  And sometimes it gets contaminated with microorganisms you probably don’t want.

There were a number of products with names that didn’t give a clue about what they were for.  So I looked up the manufacturers, got their list of products, then found the ingredients. 

As an aside, I have to imagine that the target market for many of these products has its bulls-eye right here in Berkeley, where the vegans look upon vegetarians as insincere poseurs, ersatz Dr. Strangelove apologists for global thermonuclear annihilation.

So imagine my amusement and the gleeful profundity of my schadenfreude when I found that the product called Okra Pepsin (sounds vegetable-y, right?) contains what the manufacturer claims to be a ‘proprietary blend’ (they don’t need to worry about me stealing the secret formula) containing bovine orchic extract.  Perhaps they use an extract of orchids that look like cows.

Not exactly.  The go to slaughterhouses, ask if there are some testicles lying around, and then, you know, extract.

Why did this teenage girl need this?  I couldn’t guess.  She was also taking products using ground thymus glans from slaughtered animals including cows and sheep and maybe other species.  And another product with adrenal glands.

Hey, in some places they consider organ meats a delicacy.