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The good, the bad, and the naturopathic.

July 20, 2009

I’m sorry to say it this way, but naturopathic medication is neither good, nor bad – it’s ugly; but ugly things have value too. The ugly duckling, the diamond in the rough, etc. It might be rough right now, but we can do a little polishing to take advantage of all the good stuff that is available. Just, let’s not kill anyone along the way, please!

I had the misfortune of seeing two cases this week where natural remedies went wrong. One was a patient who had unexplained hyperkalemia. EKG had pointy T-waves. He was taking several nutrition supplements/boosters, each of which contained a large dose of potassium. Plan: discontinue use.

The second was a case of accidental ingestion of a remedy meant to regulate blood glucose. Neither the pharmacist I spoke with, nor the poison control person, nor the natural medicine books we consulted, knew the mechanism of action, half-life, side-effects, safe levels, or treatment for overdose of this tablet. Plan: watch and wait

Now, that’s fewer cases in a week than I see of Western medications ‘going wrong’ but we hand out a lot more Western medications and deal with people who do trust in this type of medicine, at least to some extent. Today a pharmacist taught me that many serious adverse events from hospital drugs are preventable, though the ‘significant’ (i.e. detectable) ones (like a sore stomach) are usually not avoidable. If we knew more about naturopathic medicines, perhaps we could also predict and prevent some serious adverse outcomes from those drugs too, nevermind harnessing the healing power that they may have to offer.

Patients have started asking me, “do you believe in alternative remedies?” How can I answer simply? It’s not a yes or a no. But there are a few things I can say:

  1. many synthetic medicines are derived from chemicals that occur in nature (eg ASA – from willow bark, insulin – from our bodies, morphine – from opium)
  2. if something is synthetic, that does not necessarily mean it is safe  (eg Stevens-Johnson syndrome, drug allergy, )
  3. if something is natural, that does not necessarily mean it is safe,- innocent sounding or not (eg arsenic, poison ivy, or salt-water IV fluid)
  4. even scary sounding natural or artificial things may have clinical utility (eg Warfarin – rat poison, radiation therapy)
  5. medications, whether synthetic or naturally derived, may have side effects or dangerous interactions (eg opiates – nausea/constipation, HCTZ causing hypokalemia)
  6. with most regulated medications – those with drug identification numbers, or DINs – we have studied the safety of that medication in animals and humans
  7. not all medications are efficacious, though a selection of synthetic and natural ones have been supported by efficacy studies (eg cranberry tablets for urinary tract infection, ACE inhibitors for hypertensive diabetic patients)
  8. some synthetic medications when taken inappropriately can be fatal (eg acetaminophen causing cirrhosis, TCA overdose, etc.)
  9. some natural medications when taken inappropriately can be fatal (eg St. John’s Wort interfering with immunosuppressants and causing rejection of a transplanted organ, ginseng taken for a pneumonia which turns into septic shock)
  10. unregulated medications (typically the natural ones) are less expensive than regulated ones because they take less time and effort to develop
  11. though natural, naturopathic medications are medications because they are thought to have some impact on your body; so, when a health care practitioner of any sort asks what medications you are on, please tell us your prescriptions, your vitamins, your natural supplements, and your recreational drugs

I guess that means I’m pro-regulation. At the risk of the cost of natural supplements increasing, at least we will find out which are safe, which work, and be able to ensure that what is on the label is in the bottle.

* NB: patient information is changed and omitted to protect confidentiality

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2 Comments leave one →
  1. July 21, 2009 7:36 am

    Good post doc.

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