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Herbal Remedies, Street Drugs, and Pharmacology

David Kroll’s recent article on thunder god vine is a great example of what can be learned by using science to study plants identified by herbalists as therapeutic. The herbalists’ arsenal can be a rich source of potential knowledge. But Kroll’s article is also a reminder that blindly trusting herbalists’ recommendations for treatment can be risky.

Herbal medicine has always fascinated me. How did early humans determine which plants worked? They had no record-keeping, no scientific methods, only trial and error and word of mouth. How many intrepid investigators poisoned themselves and died in the quest? Imagine yourself in the jungle: which plants would you be willing to try? How would you decide whether to use the leaf or the root? How would you decide whether to chew the raw leaf or brew an infusion? It is truly remarkable that our forbears were able to identify useful natural medicines and pass the knowledge down to us.

It is equally remarkable that modern humans with all the advantages of science are willing to put useless and potentially dangerous plant products into their bodies based on nothing better than prescientific hearsay.

Ancient Sumerians used willow, a salicylate-rich plant that foreshadowed modern aspirin. Digitalis was used by the ancient Romans long before William Withering wrote about its use for heart failure. South American natives discovered that chinchona bark, a source of quinine, was an effective treatment for malaria. These early herbal remedies pointed the way to modern pharmaceuticals. How many other early remedies fell by the wayside? What else did the Sumerians, the Romans, and the natives use that did more harm than good? If “ancient wisdom” exists, so does “ancient stupidity.”

Plants undeniably produce lots of good stuff. Today researchers are finding useful medicines in plants that have no tradition of use. Taxol, the cancer-fighting product of Pacific yew trees, was discovered by the National Cancer Institute only by screening compounds from thousands of plants.

There is a reason pharmacology abandoned whole plant extracts in favor of isolated active ingredients. The amount of active ingredient in a plant can vary with factors like the variety, the geographic location, the weather, the season, the time of harvest, soil conditions, storage conditions, and the method of preparation. Foxglove contains a mixture of digitalis-type active ingredients but it is difficult to control the dosage. The therapeutic dose of digitalis is very close to the toxic dose. Pharmacologists succeeded in preparing a synthetic version: now the dosage can be controlled, the blood levels can be measured, and an antibody is even available to reverse the drug’s effects if needed.

“Ancient wisdom” argues that if an herbal remedy has been used for centuries, it must be both effective and safe. That’s a fallacy. Bloodletting was used for centuries but it wasn’t effective and it did more harm than good. If a serious side effect occurred in one in a thousand recipients of an herb, or even one in a hundred, no individual herbalist would be likely to detect it. If a patient died, they would be more likely to attribute the cause to other factors than to herbs that they believed were safe. Even with prescription drugs, widespread use regularly uncovers problems that were not detected with pre-marketing studies.

Arguments in favor of herbal remedies include:

  • They’re natural. (So what? Strychnine is natural.)
  • They’re safer than prescription drugs. (Maybe some are, some aren’t; how would you know?)
  • They’re milder than prescription drugs. (That would depend on the dosage of active ingredient.)
  • They’re less likely to cause side effects. (When they have been as well studied as prescription drugs, they may turn out to have just as many or more side effects. All effective drugs have side effects, and if an herbal medicine has fewer side effects it might have fewer therapeutic effects too. Formal systems for reporting adverse effects have long been in place for prescription drugs; not so for herbal remedies.)
  • They’re different from prescription drugs. (Some are identical to prescription drugs, like red yeast rice which contains the same ingredient as prescription lovastatin; and some herbal products have been found contaminated with prescription drugs.)
  • They’re less expensive. (True, but is a cheaper, inferior product a good bargain?)
  • They’re easier to obtain. (True, you don’t have to make an appointment with a doctor; but that means you don’t get the benefit of a doctor’s knowledge.)
  • The mixture of ingredients in a plant can have synergistic effects. (This is widely claimed but almost never substantiated. The other ingredients are just as likely to counteract the desired effect or to cause unwanted adverse effects.)
  • For every disease, God has provided a natural remedy. (Perhaps this is a comforting thought for believers, but it is not based on any evidence and is not convincing to atheists and agnostics. And it doesn’t help us find that natural remedy.)

Even when an herbal remedy works, finding a safe and reliable source is problematic. Horror stories abound:

  • Contaminants (such as heavy metals, pesticides, carcinogens, toxic herbs, and insect parts).
  • Wild variation in content (from no active ingredient to many times the amount on the label).
  • Mislabeled products that contain an entirely different herb.

I won’t list specific examples here; they are easy enough to find. I’ll just say that natural medicines are not regulated the way prescription drugs are, thanks to the infamous Diet Supplement and Health Education Act (DSHEA) of 1994.

When you take an herbal remedy, you are taking

  1. An active ingredient that usually has not been adequately tested,
  2. Other components that have not even been identified, much less tested,
  3. An uncertain amount, and
  4. Possible contaminants.

The term “street drugs” comes to mind: you don’t really know what you’re getting.

Posted in: Herbs & Supplements

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38 thoughts on “Herbal Remedies, Street Drugs, and Pharmacology

  1. Jan Willem Nienhuys says:

    “Ancient wisdom” argues that if an herbal remedy has been used for centuries, it must be both effective and safe. That’s a fallacy.

    The prime example is not bloodletting (which isn’t a herb) but birthwort which had apparently a good name, but which contains aristolochic acids – which will ruin your kidney and which is one the most carcinogenic substances. The Belgian accident is THE horror story concerning what can go wrong with herbs.

    One problem with herbs is that they may interfere with other medication (birth control pills, immunosupressive drug for transplantation patients). There are many examples. Some of these herbs influence the ability of the blood to clot. One may not notice that, but it can have serious consequences if you have an accident and/or need immediate surgery.

  2. windriven says:

    Wisdom of the ancient variety must have been acquired early – because life was short. Before the 19th century average lifespans in Europe hovered around 35 years*. Modern medicine has to share the credit for accelerating lifespans with improvements in sanitation and better nutrition**. But it doesn’t have to share credit with herbology, reiki, or the rattling of chicken bones while reciting magical verses.

    Modern medicine has eradicated smallpox. It has all but eradicated polio. It has all but eradicated mumps, measles, rubella and tetanus in areas where the luddites and snake charmers haven’t blocked it.

    Of course one has to give credit where credit is due. Herbal remedies have wiped … oh, wait … damn … nothing … never mind.

    *take your pick of sources, consensus is around 35. Here’s one: http://baltimoreteacher.com/docs/wh/6/3-32.pdf
    **http://www.sacemaquarterly.com/aids/every-generation-needs-a-new-revolution-200-years-in-the-history-of-longevity.html

  3. Thanks for the article Harriet Hall, a very succinct summary of important concerns about herbal remedies.

    In addition, I think the unequivocal belief that herbs are better than pharmaceuticals led to the following story.

    Recently I was talking with a friend who’s older teenage son had been diagnosed with ADHD. She talked about how she had struggled to keep him off Ritalin in spite of the suggestions of teachers, counselors, doctors. She then mentioned that she found out that he had been smoking pot and at the same time been doing better in school. She, apparently felt that pot was a better solution than Ritalin. This made me pretty sad.

    Street drugs indeed.

    ————

    Windriven – I’ve always been a little fascinated with ethno-botany. Recently I read about Curare – the poison used in south American rain forest tribes for hunting. It’s my understanding that this poison plant, when researched in science, was the basis for some important medical discovers. Sure, it’s not curing Polio, but working with curare did seem to be an important discovery in surgery and anesthesia (it’s not longer used, replaced by synthetics.) http://en.wikipedia.org/wiki/Curare

    I personally wouldn’t be inclined to discount the discoveries of previous generations, particularly when they are using some tool, herb or substance that has intriguing properties. But I also think it’s important not to accept these discoveries whole cloth. If they are useful jumping off points for science, that seems like a time saver to me.

  4. Also intriquing was a TV show (NG or Discovery, I suppose) on a scientist who was attempting to find spider venoms to be used in anesthesia by using a bird…I think it was a brown thrush, to identify poisonous spiders. Sadly I can’t find any reference of that on the web.

    I’m glad that those anesthesiologists are putting their fascination with poisons to good use. ;)

  5. S.C. former shruggie says:

    micheleinmichigan

    If they are useful jumping off points for science, that seems like a time saver to me.

    That’s just it. They make good questions to investigate, but CAM centers promote them without the studies, often with postmodern-ish accusations that actually investigating them makes you a meanie.

    I took an ethnobotony course, and my research for that class did not make me confident in the published literature. Ambiguous results and small sample and effect sizes were common (read: perfect storm for false positive.) Negative results were regularly dismissed and new studies demanded. Special pleading that lower standards of evidence (or pragmatic studies) were needed were the rule, not the exception.

    There are a heck of a lot of suspicious journals that publish entirely ambiguous or impossibly glowingly positive results, anecdotes, and case series, and while they look like other journals and/or professional bodies, they’re full of subtle political undertones.

    Being an undergrad, it took me a while to figure out something was amiss. I think a few too many emotional appeals and statements of political solidarity with the people gradually creeped me out.

    CAM makes a mess of the literature. If I get to grad school, sorting through it will be a huge headache.

  6. S.C. former shruggie says:

    So in short, yes, they’re a jumping off point, but an unwillingness to let failed ideas go makes it hard to tell which herbal remedies are already sunk and which ones are worth investigating.

    There are some stubborn academic black knights out there with no legs.

  7. Joe says:

    Thanks, Harriet, for a great article.

    The herbs that worked (as cited above) usually have quick and dramatic effects. Otherwise, I agree with S. C. that ethnobotany is not very useful. For one thing, if you look at lists of native uses for herbs, each one usually has a large number of indications. Plus, third-world herbalists don’t have intelligible diagnoses. So the ethnobotanists have to guess what they mean- yet they are not medically qualified. For example, an herb said to cure dry-mouth may mean they used it to treat diabetes; and it doesn’t mean that it works.

    In addition, there are examples of “ancient stupidity.” For example, the birthwort mentioned by Jan Willem Nienhuys, is one example. It was given to women after childbirth because the flower resembles the birth canal. Since kidney failure takes a while, its high toxicity was never connected to it.

    Another example comes from a massive campaign in China (ca. 1970) to screen herbs that were traditionally used to treat malaria. Out of more than 100 herbs, only one (artemisia) was active against malaria.

    Finally, guidance from ethnobotany can lead to screens not being done. Consider an herb promoted for 10 cures that fails all tests. Maybe there is something for which it is effective that never gets tested because it isn’t on the ethnobotanist’s list.

  8. S.C – “There are some stubborn academic black knights out there with no legs.”

    I would love to disagree with you, but your metaphor is too compelling. ;)

    I would have gone for the “you have to know when to hold em, know when to fold em…” But, monty python wins out.

  9. To be more clear, I was not supporting the idea that the ancients have reliable cures for certain diseases or promote CAM. I was only suggesting that people who have lived in an area for hundreds or thousands of years have a good amount of experience with some of the effects of local plants. I did not mean to suggest that we try to provide evidence that the plants they have chosen as cures for a disease are in fact cures for that disease.

    I am only suggesting that if you have an incredible range of plant species that you are evaluating the observations of effects from local folks may be helpful. This plant makes your heart beat fast, hmmm. sort of thing.

    S.C. shruggie – In spite of the fact that I don’t want to be a meanie, If what you suggest about the current field of ethnobotany is accurate, that seems unfortunate to me. Not what I had in mind.

  10. Joe says:

    micheleinmichigan on 22 Mar 2011 at 11:59 am wrote “… I am only suggesting that if you have an incredible range of plant species that you are evaluating the observations of effects from local folks may be helpful. This plant makes your heart beat fast, hmmm. sort of thing.

    It is hard to quantify that; but my overall impression is that the local folks are not reliable for identifying therapeutic substances. Your example, making one’s heart beat fast, is rare and seems to exemplify my idea that they can only identify stuff that works quickly and impressively. Ephedra can make your heart pound; but it is unsafe to take.

    You are right that the locals may be able to identify some potently active substances; but one doesn’t know what they really work for, if anything. David Kroll’s recent post (thunder god vine) shows that locals can point to powerful, and useful, substances; but not necessarily therapeutic agents.

    I dare say the alleged safety of most herbs is a result of the fact that they are no more biologically active than lettuce (and the fact that there is no research to investigate their safety).

  11. Joe “You are right that the locals may be able to identify some potently active substances; but one doesn’t know what they really work for, if anything. David Kroll’s recent post (thunder god vine) shows that locals can point to powerful, and useful, substances; but not necessarily therapeutic agents.”

    Yes, I think we are on the same page.

    Also, since I was using poisons (a muscle relaxant herb that causes paralysis that results in death unless the subject received respiratory support) as my examples, I can assure you, that I’ve ruled out the ‘herbs are safer than synthetics’ myth.

    This is probably due to the amount of poison ivy in my yard.

    The interest in ethnobotany is probably just my arts background, culturally, arts folks are generally irredeemably thieving magpies. Don’t see how any other discipline can resist.

  12. Wolfy says:

    Great article!

    What is sad to me (as a medicinal chemist and oncologist) is that fewer and fewer labs in both the pharma and academic sectors are interested in natural product isolation. In pharma, high speed analog synthesis and high throughput screening are less time consuming ways of isolating biologically active compounds.

    There are, however, a few noble labs where folks are isolating cool compounds from sponges in the deep sea or unusual trees that grow in Brazil.

  13. pmoran says:

    I’ve also often puzzled over how ancient herbalists ever usefully matched up a herbal remedy to a medical complaint. The hurdles are immense.

    Malaria, for example, comes and goes naturally and erratically. Without careful systematic observation and record-keeping, how would it be determined that cinchona bark or bits of Artemesia Annua worked better than dozens of other possible herbal choices?

  14. Joe says:

    @pmoran on 22 Mar 2011 at 5:00 pm

    In the case of cinchona, I think the effect was quick and dramatic.

    In the case of artemisia, I think its discovery was just random because the plant does not always produce artemisinin and because preparations from plants that do make the drug don’t always contain artemisinin because it has an unusual solubility profile. So, nobody really knew that it was better than the alternatives; it was just used.

  15. pmoran says:

    Joe, Wikipedia has an interesting account of how Cinchona came to be used under “quinine”.

  16. LMA says:

    windriven — you’ve failed to give “credit where credit is due” in at least one instance I can think of right off the top of my head — yew tree extract for ovarian cancer.

    LMA

  17. Dr. Le Petomane says:

    Great article. I might put this in my waiting room.

  18. Scott says:

    @ LMA:

    Credit is not due to herbal remedies there. Yew tree extract was not used by herbalists.

  19. Jan Willem Nienhuys says:

    @ LMA on 22 Mar 2011 at 7:54 pm
    Windriven wrote

    Herbal remedies have wiped … damn … nothing

    you criticise him for not mentioning taxol. But a ‘herbal remedy’ as discussed by Harriet Hall is some kind of entire herb preparation that is traditionally used. Taxol was found by systematically examining many plants. No one was using ground up taxus twigs for anything. A large number of medicines old and new is derived from plants. Harriet Hall mentions a few. But her example digitalis shows what is the problem. Withering examined a herbal mixture and found that one of the twenty plants was the active ingredient. The herbal mixture was a remedy against ‘dropsy’ (edema from congestive heart failure). I don’t know whether at that time it was known that the heart had anything to do with dropsy.

    pmoran implictly mentions quinine: the Peruvian Indians used it against shivering due to low temperature. Jesuits, familiar with the shivering of malaria patients, tried it on these patients. So if this story is true, the cinchona bark wasn’t used at all by the Indians for malaria.

    Secondly, even though taxol is useful in the treatment of breast cancer, windriven is completely right. Taxol hasn’t wiped out breast cancer, and certainly no traditional herbal prepation has done anything like wiping out a disease like smallpox vaccination did.

    One might complain that windriven is setting the standards too high. Opium and its derivatives have alleviated a lot of pain, and colchicine from Colchicum autumnale was already in use against gout in Roman times.

  20. vicki says:

    Life expectancy is a little complicated: for most of history, “life expectancy at birth” looks very different from “life expectancy at age 5,” for example. So an average life expectancy of 30 doesn’t mean many people dying at 30: it’s likely to be high infant mortality, then a lower (but higher than we’re used to) death rate from infectious disease and accidents, and then a lot of women dying in childbirth and men being killed in battle. But there may well be many people in their 40s, even 50s or 60s, which is time to have grandparents and village elders and other people who can pass knowledge on.

    I do not want to trivialize the value of reducing infant mortality: not watching your babies die is huge.

  21. LMAO says:

    Dr. Le Petomaneonwrote:
    Great article. I might put this in my waiting room.

    Yes, yes, yes! And EVERY conscientious practitioner who visits this site should follow suit.

    If only it would make any difference.

    My husband’s sister is over the top with this stuff, and getting worse as the years go by. It worries me senseless, but it’s a religion or an addiction, and challenging her belief system is as effective as trying to convince a religious fanatic that they are actually on the road to hell, or a drinker that he’s an alcoholic.

    It’s already bad enough the money shoved into the pockets of the snake oilists–that one issue is worrisome enough. But what’s really bad is how these believers seem to escalate–has anybody else noticed that? It starts with a little aloe vera on a burn and next thing you know they’re doing an unsustainable elimination diet and multiple herbal concoctions all prescribed by some chiropractic herbalist.

    I’ve gone from worried to downright frightened for my SIL… I love her dearly and I hate seeing her sucked into all this garbage. I will send her a reprint of this post, but I’ll do it knowing that, even if she actually reads it, she’s 99% likely to simply dismiss it.

    Opening the eyes of the true believers strikes me as a bit of a lost cause, but if trusted practitioners put the information prominently in front of them, and then keep relentlessly harping on it, there’s a tiny chance of saving a few good souls.

  22. Zuvrick says:

    vicki’ spoint is good, but you are all too biased by the European hostory of the last 500 years, I fear. Life expectancy in many traditional groups was quite long. Dr Weston Price twaveled the world over in the 1920; and ’30s looking for peoples who had been influenced by Western living. He found many eaxmples of extremely healthy individuals. He was a research destist and looked at overall health mistly from the dental conditions encountered. His book, written in 1939, is a landmark describing the adverse effects of modern foods introduced in areas where some people kept to a traditional diet and others had switched over.

    I think many groups that he saw had life expectancies as great as ours or better because there were virtually no degenerative diseases and generally few infectious ones. If you don’t believe me read the book. Surprisingly, diets varied enormously, but the more healthy groups consumed lots of fats, especially from animals. Of course, everybody today has been brainwashed by the heart-cholesterol myth, by far the greatest breach of science on a mass scale that has ever been perpetrated by so many for so long.

    As for how primitive man knew what herbs and foods to take and use, many things came in dreams and “feelings” that we don’t get because our intellect has been stimulated and developed in an entirely different direction. They were far smarter than we are in many ways, yet we are far smarter in many other ways.

    zu

  23. Zuvrick says:

    Errata (arrgh):

    “Dr Weston Price traveled the world over in the 1920 and ’30s looking for peoples who had **NOT** been influenced by Western living.”

  24. windriven says:

    @Zuvrick

    One can find all sorts of outliers whether in life expectancy or the girth of the left great toe. What matters is average life expectancy and quality of life. There are many influencing factors including genetics, sanitation, exercise and nutrition as well as medical care.

    Moreover, your intrepid dentist conducted his travels nearly a century ago, back when scientific medicine was in its infancy. The more I consider your comment, the more I wonder what your point actually is.

  25. Harriet Hall says:

    Zuvrik,

    Weston Price traveled the world and found what he wanted to find. He didn’t do any systematic or quantitative assessments and he ignored alternative explanations. It’s called confirmation bias, not science. He is not a source of credible information. He is identified on Quackwatch as a promoter of questionable methods.

    ” If you don’t believe me read the book.” Polemics in books do not convince me; scientific evidence does. Do you believe everything every crank writes in a book? Much of what Price said is inconsistent with modern scientific medical knowledge.

    The cholesterol myth is not “by far the greatest breach of science on a mass scale.” Have you been influenced by the propaganda of the International Network of Cholesterol Skeptics? They have created their own myth based on distortions and misunderstandings of the evidence. See http://www.sciencebasedmedicine.org/?p=22

    The idea that dietary cholesterol caused heart disease was an error that originated in preliminary science and was corrected by better science. While it is true that reducing cholesterol in the diet has little effect in preventing heart disease, it is also true that blood cholesterol levels are a major risk factor and reducing them reduces the risk. Statin drugs save lives.

    “Life expectancy was quite long” in traditional groups?! I don’t think so!

  26. Nikola says:

    Thanks for an excellent article, Harriet!

    “They’re different from prescription drugs. (Some are identical to prescription drugs, like red yeast rice which contains the same ingredient as prescription lovastatin; and some herbal products have been found contaminated with prescription drugs.)”

    Herbal products contaminated with prescription drugs? I don’t quite understand this. Could someone elaborate?

  27. Jan Willem Nienhuys says:

    Consult http://www.performanceinsiders.com/libidfit.html

    this is advertised as natural and herbal (containing among others a selection of Panax ginseng, Rehmania glutinosa, Radix Angelica sinensis (Dong Quai), Rhizoma polygonati, Lycium barbarum, Atractylodus macrocephalae, but the capsules contain large amounts of analogues of sildenafil (VIagra). There are many of this kind of ‘herbal’ cures. Other examples are admixtures of corticosteroids in ‘herbal’ ointments.

    http://www.aafp.org/afp/990800ap/tips/15.html
    http://www.bmj.com/content/318/7183/563.full

    Maybe you would like to read the following scam about ‘herbal’ contraceptives:
    http://www.nation.co.ke/News/-/1056/627760/-/ul14aw/-/index.html

    Maybe you think that these do not precisely correspond to ‘prescription medicine’ in herbal preparations.

  28. Joe says:

    @Nikola on 03 Apr 2011 at 5:55 am

    Red yeast rice contains a statin drug. But one doesn’t know how much or what else contaminates it. It is safer to take the pharmaceutical product.

    Also, some herbal (and homeopathic) products are made with real drugs added (or else they would have no effect). These undisclosed ingredients can make a product dangerous. Formulations of “herbal viagra” are notorious for this. If you have a condition that prevents you from taking viagra, taking the “herb” can be deleterious to your health.

  29. Nikola says:

    Ah, so basically some herbal products have *active ingredients* found in prescription drugs, right? Therefore taking the herbs without being aware of their presence, let alone the dosage, can be dangerous. I think it’s a bit clearer now in my mind:)

  30. Harriet Hall says:

    @ Nikola,

    More than that. Actual prescription drugs, things that never occur in plants, have been found in herbal products. Someone deliberately added them.

  31. Scott says:

    @ Nikola,

    Though what you said was right too. There are basically three classes of herbal products:

    1. Those which contain no active ingredient. In this case they’re effectively very expensive salad in very small quantities. Often don’t taste good, even.

    2. Those which have been adulterated with a pharmaceutical. As Joe said, “male enhancement” “herbs” are particularly notorious for this. Highly illegal and dangerous. If that drug is appropriate for the user, said user should get a prescription.

    3. Those where the herb naturally contains a pharmacologically active ingredient (e.g. red yeast rice). In this case, taking the herb is taking a drug of unknown dosage and poor purity. In most cases said drug is also untested for efficacy, safety profile, appropriate dosage, etc. Not illegal, but dangerous and of highly questionable efficacy.

    You’ll note that in none of these categories is taking the herb a good idea…

  32. Nikola says:

    @Harriet Hall & Scott

    Holy crap. That is much scarier than what I originally envisioned. It seems that yet again I have to “upgrade” the dangers of CAM nonsense, especially when I try to explain some of this to other people.
    Thanks.

  33. billyboy says:

    Ms. Hall, I enjoyed your well-written article. There is a lot of truth there. However, I submit that there is at least one nutraceutical company in the world that is researching and producing herbal supplements at a pharmaceutical level of quality and safety. This company is Univera. I direct you to their Univerescience.com site. The navigation menu has much information about the high level of scientific research that is done in order to overcome all the hype, misinformation and hazards of using botanical products. There is also a more technical section that is usable only by registered health care practitioners.

    One thing that was not brought up in your article is the fact that a lot of people turn to CAM because traditional medicine has failed them in some way. I had suffered with increasingly painful knee joints for 10 years, and all my doctor could do was give me something for the pain. I started taking two Univera nutritional products and in four months I experienced astonishing improve-
    ment in comfort and mobility. I am a painter, age 60, so the change was obvious, on a daily basis. And I never have to take any pain medication, even ibuprofin.

    My wife has had a different experience. She has suffered from chronic fatigue for about two years. Her doctor has done every test in the book and keep telling her there is nothing they can do.
    They tell her all the numbers are “normal”, even though she feels exhausted. She feels just as bad when she gets up in the morning. Her research and family history indicate a hyper-thyroid condition and her blood tests show she is consistently at the very bottom of “normal” range. so the doctor is telling her that there is nothing wrong and she should learn to live with minimal health. I think this attitude sucks. I won’t settle for less than optimum health. So she has turned to some recommended herbal supplements and she is beginning to feel better after only three weeks. Of course this is subjective, but she has consist- ently( for 5 days) had more energy after work. Only time will tell, but she now has a lot more hope than the doctor gave her.

    I think the use of herbal supplements will continue to increase. We now have the scientific technology to see how they affect us, even down to the genomic level.

  34. Scott says:

    @ billyboy:

    I took a look at that site (took me a bit to figure out that you’d misspelled the URL, but that can happen to anybody). There is NO meaningful scientific research there at all, much less a “high level.” I found not a single peer-reviewed paper supporting their claims. It’s all very “sciency” – tables, articles, titles, citations. But nothing peer-reviewed, and therefore nothing in which any reliance can credibly be placed.

    Your anecdotes are nothing more than examples of confirmation bias, selective memory, and/or placebo effect. Note that the conditions mentioned are those which are EXTRAORDINARILY susceptible to such (pain and fatigue).

  35. Harriet Hall says:

    @billyboy:

    As I entered my 60s, I developed shoulder pain with severe limitation of my range of motion. It hurt to raise my arm. I was unable to reach behind my back to fasten my bra, so I had to put it on backwards, fasten it in front, and then turn it around. When I needed something from a high shelf, I would ask my husband to get it for me. After this had persisted for over a year, I was resigned to having this permanent limitation, to “living with less than optimum health.”

    I tried a natural treatment, we’ll call it treatment X, and my pain disappeared. Suddenly one day I realized that I could once again fasten my bra the normal way with no pain at all. I have a full range of motion again, with no pain or limitations.

    If you are wondering what treatment X was, it was only Tincture of Time. I took no pain pills, did no exercises, had no treatment of any kind. The problem just spontaneously resolved. If I had used Univera products I would have falsely given them the credit for my recovery. Anecdotes like yours and mine illustrate why science is so important to help us figure out which of our beliefs correspond to reality.

    The Univera website is a typical example of a multitude of similar companies making unfounded claims and offering income opportunities. For a similar example, I refer you to my article on Protandim http://www.sciencebasedmedicine.org/?p=852

    Please note: I am not saying you should stop using an herbal product that you think is helping. I’m just saying you can’t be so sure that it really is helping.

    By the way, it is customary to address an MD as Dr. rather than as Ms. Some people deliberately omit the title as a subtle insult. I hope you intended no disrespect.

  36. BillyBoy – “Her research and family history indicate a hyper-thyroid condition and her blood tests show she is consistently at the very bottom of “normal” range. so the doctor is telling her that there is nothing wrong and she should learn to live with minimal health. I think this attitude sucks. I won’t settle for less than optimum health. So she has turned to some recommended herbal supplements and she is beginning to feel better after only three weeks. ”

    I had a similair experience before I was diagnosed with thyroid disease. If she is the bottom end of normal range (it’s hard to tell if you are talking about TSH or another test, usually low TSH levels wouldn’t cause fatigue, they might cause sleeplessness though), I would recommend seeing another doctor. If her feeling of fatigue are really out of the ordinary (for her), then perhaps she could push for antibodies tests for autoimmune thyroid. If those are positive, then she might have more luck getting treatment.

    Thyroid disease (if she did have that) tends to eb and flow. So feeling better for a few weeks is not really significant. I wouldn’t waste time on supplements, if they make her feel better, they may actually be doing something else that could be harmful.

    I would consult another doctor AND I would also be aware that sometimes it takes a while to get things figured out. It sucks, but once you get a good diagnoses and good treatment, it makes a world of difference.

    I’m not a doctor, or even a medical person. So please take my advice with a grain of salt.

  37. Scott says:

    Low TSH DOES cause fatigue. Well, not directly – the high T3/T4 cause both fatigue and low TSH in hyperthyroidism. The effect may be a bit counterintuitive, but it’s kind of like you just finished a strenuous workout – all the time.

    The diagnosis makes sense from the information provided. The treatment just doesn’t. Unless the “herbs” were in category 2 or 3 from my prior post, in which case it’s far more dangerous to use them than the proper medications.

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