Natural Supplements vs prescription drugs continue to be a confusing issue

The argument against supplements goes something like this.  "Just because it's natural, doesn't mean it's safe". There is, of course, some truth in that statement and many medications are made from natural substances as well.

The FDA is uncomfortable with natural supplements and remedies because they cannot control them as they do other medications.  Recently we have heard about the FDA banning ephedra because it is so dangerous and because it can cause sudden heart attack.

Ephedra, a stimulant, is the energy part of several 'fat burning supplements' which contain Ma Huang, another name for ephedra, the base used by coke labs to make meth-amphetamine. 

Often these supplements make the ephedra more powerful by combining it with cayenne pepper and caffeine.  These are in widespread use in our society which considers getting fat worse than being blind, and although most people can tolerate them, stimulants have never been conducive to good heart health. This is because in 'raising your metabolism', stimulants make your heart beat faster. 

Products having ma huang/caffeine/cayenne combinations include Ignite, Thermotrim, Ripped Fuel, Metabolife, Diet-Phen, and Exercise in a Bottle. In fact, there are over 200 supplements containing Ephedra to be found in Health Foods stores and available on infomercials and through the Internet.

That ephedra is even involved in any sudden heart attacks is controversial.  Sudden heart attack is apparently caused by an electrical short and a more likely candidate for this, is the disordered eating which many athletic people follow to keep their bodyfat level so low.

It also should be noted that medications like Phentermine which do essentially the same thing as ephedra were NOT banned by the FDA.

This leads one to wonder if the banning of ephedra was to force ephedra users to buy prescription drugs.

From time to time, discussions of "unsafe" supplements get in the health headlines.  Discussions of even unsafer medications seem to never make much news.  

The following supplements were suspected of not being safe, despite being natural.  

In the products called Zen, NRG-3, Soma Solutions, Enliven and Serenity, the FDA found an industrial solvent called 1,4 butanediol (BD). This chemical is causing the same dangerous symptoms as seen with the so-called "date rape" drug, gamma-hydroxybutyrate (GHB), among other things because it is metabolized into GHB in the body, the researchers said.   BD and related chemicals are commonly sold as sleep aids, weight reducers and muscle promoters and even as "organic" cleaning products. BD ingestion causes extreme euphoria and sedation, but can lead to severe respiratory depression and coma. Despite warnings issued by the Food and Drug Administration (FDA), the BD containing supplements still seem to be in widespread use.

Another 'natural' supplement, Anso Comfort Capsules, which were sold by Arcadia, California-based NuMeridian via telephone and mail order, contains a powerful sedative drug, "Librium" which is NOT listed on the label. The FDA recently warned consumers to avoid this supplement which can cause drug interactions and other side effects.  In other words, the FDA wants you to get your doctor to prescribe it.  But in defense of the FDA, I think I'd like the ingredients, especially a potentially habit forming sedative, to be listed on the bottle.

St John's Wort (which is similar to Prozac) and red rice yeast (which is similar to the statin drugs i.e. zocor, lipitor, prevastatin et al, for lowering cholesterol) are two more natural products which should be approached with caution.  They likely carry the same risks as the pharmaceutical versions (Prozac has been shown to injure serotonin receptors in longer term rat studies and statin drugs have been observed the raise the risk for cancer).  Bottom line, if you wouldn't feel comfortable taking the pharmaceutical equivalent, you probably would want to skip the natural product which is essentially the same thing.

Chromium Piccolate, hawked as a miracle supplement which 'burns fat' without exercise and still included in such products like "Exercise in a Bottle", also has its dark side. The Piccolinate part is a neuro-toxin according to several studies. Additionally, double blind studies on the product have shown no benefits as far as 'fat burning'. Yet it's still widely sold even as we speak.

Kava is promoted as relieving anxiety, stress and insomnia. A member of the pepper family, it has long been used as a ceremonial drink in the South Pacific. Until recently its biggest danger seemed to be in drinking too much of the sedative before driving. Then, about two years ago, kava in pill form suddenly boomed, bringing in about $30 million (U.S.) in sales.  At the same time, some reports of liver toxicity began to filter in from the US and Europe.  Kava is sold under a variety of names, including: ava, awa, intoxicating pepper, kava root or pepper, kawa, kew, Piper methysticum, rauschpfeffer, sakau, tonga, wurzelstock and yangona.  If you decide to take Kava, you should be monitored for liver enzyme levels.  It might be best to skip this one.

The argument that pharmaceutical drugs are safer than supplements goes like this - medications are extensively tested before marketing, pharmaceutical manufacturers must continue to monitor their products for ill side effects and also, when you take a pharmaceutical medication, they are forced to list all their ingredients and provide detailed information about the action of the medication.  Additionally, you must obtain a prescription for a medication from a person who is highly educated in the side effects and repercussions of the chemical.

The listing of the ingredients on medications is a plus but then often in the prescribing literature, pertinent questions are answered with "unknown" or "uncertain". 

It is true that they have studies published in peer reviewed journals but pharmaceuticals apparently routinely pull reports on adverse side effects before presenting information to the FDA.  This came out in the Phen-Fen trials when Wyeth-Ayrest admitted to suppressing the adverse results of the Phen-Fen studies.  They petitioned that the evidence of this be unacceptable in court.  "It's common practice in the pharmaceutical industry to suppress adverse results," they told the court.  Their petition was granted.  Even more shocking was that although this appeared in the news, no one even paid attention to it or pondered the overwhelming effect it would have for a pharmaceutical company to suppress bad results - in other words, it would allow unsafe drugs to go to market.

The continued monitoring of drugs done by the manufacturers does eventually show the medication for its true colors but often not before thousands of people are injured or harmed.  And there has been quite a bit of monitoring on the natural supplements as well.

Lately, empirical medicine has taken an interest in some natural products and found them to be not only relatively safe, but extremely helpful:

CoEnzymeQ10 is something which occurs naturally in the body but of which we have less as we age.  It has been observed to be protective of the heart and liver and also, to strengthen immunity significantly.  In the petrie dish, CoEnzymeQ10 will actually kill cancer cells.  (see: www.cancer.gov )

Natural Progesterone Cream is made from yams - and has been shown to be helpful in avoiding a hysterectomy for hormone imbalance experienced by many menopausal women. As we have recently seen, pharmaceutical hormone therapy raises the risk for cancer, heart attack and stroke.  Natural Progesterone Cream is thought to lower the breast cancer risk and may actually lower the risk for heart attack.  (see WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT MENOPAUSE by John Lee, MD)

Glucosamine Chondroitin has been tested in a few double blind studies. It (like CoQ10) is something which we have in our bodies but make less of as we age and is thought to be protective against arthritis.  In two double blind studies, those who took glucosamine chondroitin had 75 percent less pain.  Many anecdotal accounts of long term usage show arthritis actually getting better (I have observed this in myself).  A caution... if you have diabetes, the oral variety of this will raise the blood sugar.  Using "JointRitis" which is delivered through the skin gets around this and you can use much less of it.

A recent development is the pharmaceutical companies producing some natural products, synthetically (go figure!).  For example, Niaspan, a pharmaceutical form of niacin, has been shown to raise the HDLs and be helpful in reversing clogged arteries.

So what is the bottom line?  A careful study of all available therapies, the risks and the benefits and discussion of these with your medical provider is best (nurse practitioners tend to be more savvy on alternate therapies).  Sometimes this can be arduous but it's worth the trouble.  Things are just very complex these days.

In comparing Natural and prescribed medications we find the line between pharmaceuticals and non pharmaceuticals to be increasingly blurred.  Which ARE really the safest?  All therapies, whether pharmaceutical or alternate, must be carefully researched:

 

Concerns Prescription drugs Natural supplements
Research Studies Extensive research process is supposed to take 4-5 years. In reality, many drugs are pushed through with minimal or lacking studies. No research is required in order to take supplement to market. But often researchers do study popular supplements. Manufacturers can claim anything they want about their product
Safety Pharmaceutical manufacturers are supposed to prove through several studies that the medication is safe for human consumption however, this is often done with rat studies (human experimentation is not allowed and although we have may some low opinions of some humans, they are NOT rats)  So in truth, the safety of a medication is only discovered after it either has bad side effects on humans or it doesn't - after being sold for many years. Supplement manufacturers need prove nothing. They usually claim their products are 'safe' saying they are 'all natural'. In truth, most natural preparations are the same sort of stuff you find in food (rather than synthetic preparations like drugs) so they are probably mostly safer than synthetics, albeit some may not be effective.
Ingredients on label Pharmaceuticals required to give details about all ingredients in the medication and details about the action of the medication. No total listing of ingredients is required from supplement manufacturers but mostly, ingredients are listed on the label or at least, listings are available from the manufacturer.
Concerns Prescription drugs Natural supplements
Ongoing monitoring Complete and ongoing monitoring is required - if safety issues come up, pharmaceuticals are required to pull drug. In truth, very few pharmaceuticals are forced to remove drugs from the market although some voluntarily do so Researchers often do double blind studies on supplements and sometimes these studies are better than those of the pharmaceuticals because they do not have an ax to grind.  Thus, the straight story is sometimes easier to find with a natural medication than it is with a pharmaceutical drug
Integrity of ingredients Heavily regulated to insure the integrity of ingredients (those who manufacture the generic drugs which most of us use, do NOT have these regulations however) Not regulated at all - they can substitute or put anything they want in 'Natural supplements'
Is medication appropriate? Used to be determined by medical providers only but drug companies now advertise on TV.  Additionally many medical providers do not keep up with the research and rely on (guess what) the drug companies to give them info about treatments. That info is, of course, very biased to whatever drug is being sold. Supplements are available without prescription however some medical providers will help people make decisions on what is appropriate.  Since they are not backed by large pharmaceutical concerns, better decisions might actually be made.
Concerns Prescription drugs Natural supplements
Complete information on included ingredients, side effects and drug interactions Available from the pharmacist, the medical provider and often bottle inserts as well as reference works like the PDR Not usually available from the manufacturers. Consumer must dig for references and because of the lack of research, some side effects are unknown

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