Is “All Natural” Really “All Good”?

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I’m a little uncomfortable with alternative and complimentary medicine. 

Before you plot my death by alfalfa sprout poisoning, let me just say that I’m not against any treatment per se – I’m just a stickler for a little thing called “evidence.”

Is saw palmetto good for the aging prostate? No. Fish oil for elevated trigylcerides? Sometimes. Riboflavin, magnesium, and butterbur for migraines? Worth a try. I will, however, not recommend a treatment simply because the words “alternative”, “natural”, “ancient” or “complimentary” are on the label.  It’s all medicine.

A technical point: “alternative,” “herbal” and “natural” supplements aren’t considered drugs by the Food & Drug Administration (FDA). Supplements are considered food, and are therefore not subject to the rigorous approval process or quality control surveillance that prescription drugs are. Providers and consumers have to rely on manufacturers to tell us about their products, often without a wealth of evidence. Suppositions without proof are advertisements, not facts.

I’m not comfortable prescribing a medication on the basis of advertisements. I’m sure there are wonderful treatments lurking out there in fields and rainforests, but I want proof of efficacy and safety before I recommend it. Let me give you a good example.

Many patients have asked me for a natural remedy for high cholesterol, a serious problem for which there’s not a “one size fits all” treatment. I consider a lot of variables: age, other health problems, family history, etc. Once you and I decide on a treatment, I check and recheck to see if it’s working and if there are any problems.

I’m asked over and over about red rice yeast, a so-called natural alternative to a category of prescription medications called statins. In fact, red rice yeast does work… because it is a statin.  It’s identical to a prescription drug called lovastatin, which means it comes with identical risks: hepatitis (liver inflammation), rhabdomyolysis (breakdown of muscle tissue), and myositis (painful inflammation in the muscles). Some commercially available preparations of red rice yeast have bonus chemicals, including citrinin, which can cause kidney failure. 1

Now, who is watching your liver, kidneys, and muscle while you’re taking red rice yeast? Not me. And Google tells me it costs between $14-30 a month. Prescription lovastatin costs $4 a month. So this treatment isn’t safer, cheaper, or more effective. So what is the advantage? Sure, you don’t need to see your doctor to get a prescription, but is saving the cost of a co-pay really worth risking liver or kidney failure?

Before you take any medication – prescription, “all-natural” or genetically engineered from mutated space alien zombie death rays – check out the evidence. There’s pharmacologic gold in them there hills, but like my mama always says, there’s no free lunch. Drugs are drugs, no matter who is selling them to you.

Victoria Rentel, MD (Student Health Services)

1. The Medical Letter, read all about it: Vol 51, Issue 1320, P 71-2, Sept 7, 2009.