Why ‘Natural’ in ‘Natural Medicine’ Does Not Guarantee Safety
Understanding natural treatment was written in order to give the reader an overview of this fascinating, albeit contentious, field of treatment. An important aspect to such an undertaking was to encourage those considering using such treatments to always balance the advice from enthusiastic advocates against the genuine concerns raised by skeptics; the final decision on whether to use a particular remedy of treatment should always be an informed decision. It is therefore the aim of this article to discuss various issues and risks associated with complementary and alternative medicine.
Many people assume that natural remedies/medicines are completely safe to use, because they are… natural. The reality though, is that in most cases, the remedy works because the extracts used (typically from herbs or other plants) contain active ingredients i.e. pharmacologically active. Although the active ingredients are responsible for the benefits observed, under certain circumstances, such as when given in too high a dose, they can produce undesired side effects and become toxic.
The notion, “If I take twice or treble the amount of the natural remedy, I’ll get twice or treble the benefits”, though erroneous, is a surprisingly common one. For example, sea kelp (Fucus vesiculosus) has been traditionally used to treat hypothyroid-related goiter (’underactive thyroid’) and serves as a general thyroid and metabolic tonic. Goiter refers to a non-cancerous enlargement of the thyroid gland that can lead to a visible swelling of the neck. However, sea kelp is rich in iodine, and exceeding the recommended daily allowance (RDA) for iodine (0.15 mg/day or 150 μg/day) can lead to hyperthyroidism ( ‘overactive thyroid’) e.g. Shilo and Hirsch 1986. This can result in numerous symptoms such as diarrhea, fatigue, palpitations, weight loss and ironically, goiter that is hyperthyroid-related.
It has been shown that a range of adverse reactions including allergies, allergic asthma, anaphylaxis, skin problems and other serious health conditions have been associated with using CAM, natural remedies and Chinese medicine. For example:
- In his abstract, Ernst 2000 makes the point that allergic reactions, photosensitization, skin issues, systemic adverse effects, toxic ingredients such as arsenic or added ingredients such as corticosteriods have been linked to various herbal remedies.
- Mullins and Heddle 2002 noted that the popular herb echinacea has been associated with allergic reactions.
- Lim and Thirumoorthy 2005 concluded that “serious cutaneous reactions do occur with traditional [Chinese] medicines”.
- Herbs such as comfrey (Bunchorntavakul and Reddy 2012) or kava (Gow et al. 2013) have been linked to hepatotoxicity/liver damage or even death.
- Concerns about ephedra and synephrine, both of which were/are used in some natural decongestants and diet pills, have been well-documented. For example, one of the key findings of Shekelle et al. 2013 review of ephedra was, “These products may be linked to catastrophic events such as sudden death, heart attack, or stroke”.
Therefore, it is apparent that one should consider natural remedies as one would any other medicine and treat them with respect.
It is important to remember that the FDA (U.S. Food and Drug Administration) and regulatory bodies in other countries do not necessarily apply regulations for CAM and therapies in the same way as they do for conventional medicine. For example, dietary supplements and herbal medicines are considered foods as opposed to drugs. The consequence of this is that even though a dietary supplement may be on sale, research pertaining to its efficacy, safety and long-term effects may not be readily available or may simply not exist.
Furthermore, a lack of manufacturing standardization may result in variations in quality and consistency between brands and even within different batches of the same lot. Although manufacturers are meant to follow “good manufacturing practices” or GMPs, this may not always occur. Poor practice can include contamination (e.g. unlabeled or incorrect ingredients, heavy metals, fungal spores), using substitute plant species or incorrect labeling of the amount of the active ingredient(s) present. Authorities monitor the safety of products on the market and have the power to issue warnings, bans or take legal action should a manufacturer make false claims or the product has been shown to be harmful e.g. ephedra.
When considering treating allergies with a natural remedy, the person should therefore have at least a basic grasp of the nature of active ingredient(s) present. A given treatment, even when safe, may utilize various components or ingredients that work synergistically to achieve the desired outcome. For example, a natural decongestant food such as blueberries contains the antioxidant Vitamin C (antihistamine and anti-inflammatory) and anti-inflammatory bioflavonoids. Angelica, which is relatively safe, has anti-inflammatory decongestant properties and is recognized as a stimulating expectorant. However, other ingredients and treatments can be far more aggressive with the risk of serious side effects if prepared or administered incorrectly e.g. Siberian Cocklebur, Trichosanthis.
Given that a particular remedy may be used for treating a variety of conditions apart from just allergies, the person must apply due diligence and be aware of any potential side effects, especially if they have a pre-existing condition or are taking other medications (both prescription and non-prescription) or supplements. Also, they need to know what constitutes safe usage and find out if there is a recommended daily allowance (RDA). Furthermore, it pays to be aware whether the benefits claimed are circumstantial and anecdotal, or whether they have genuine and verifiable scientific backing.
The need to be diligent applies equally to various other forms of CAM besides natural remedies and supplements. Take time to gain a working knowledge of any therapy you are considering (how it works, its pros, cons and potential side effects) before undertaking it, and always make sure that the practitioner is qualified and an expert in their field of study. It’s amazing how some people will go to great lengths to find a suitable licensed dog breeder when buying a dogyet when it comes to themselves, they take on face value the qualifications hanging on a wall of a so-called expert in a therapy that is probably self-regulated i.e. not regulated in a similar manner to conventional medicine practitioners. To highlight this point, remember that in the U.K for example, only 2 forms of CAM are currently subject to statutory professional regulation (osteopathy and chiropractic) and even then, regulation serves to protect the patient’s safety and does not imply the treatment is proven to be scientifically effective.
Therefore, don’t just take the practitioner’s word for it – check who they are and what their qualifications represent! Take the time to search out the practitioner online and read their website; does it inspire confidence when compared to others in their field? Search around for satisfied or disgruntled customers and consider other potential recommendations. Also, depending on the type of CAM therapy, there may be local/national agencies or professional associations and/or voluntary registers that can provide information on those practitioners who have registered with them. They may have data on how long the practitioner has been qualified and licensed, what training they have undertaken and their level of expertise, what they currently specialize in, as well as issues such as whether any formal complaints have been made against them. Furthermore, they will be able to give you guidelines concerning how much you can expect to pay for treatment. In addition, consider visiting any prospects prior to starting treatment in order to get a feel for both the premises and the practitioner. Does the practice seem professional, hygienic and do you feel comfortable with the practitioner? It often comes down to a gut reaction and the golden rule is – if in doubt, don’t!
As a precaution, any of the following groups should consult a health care provider before taking CAM and supplements: women who are pregnant or breast feeding, children, anyone who is due to have surgery or who has a pre-existing medical condition and/or are taking medication. Finally, anyone who experiences side effects should stop their CAM and consult a medical practitioner. If significant, consider reporting your experience to a recognized health and safety information gathering service, such as FDA MedWatch.
