Metabolic Medicine – The State of the Union
CMP’s refer to conventional medical practitioners.
When I first started practicing as a health and wellness-consulting pharmacist, the people who sought out my services were usually just passed off as “health nuts.” I think many people thought that natural medicine was probably a passing phase, thinking surely the use of vitamins and minerals, herbal products, other nutraceuticals, homeopathy, and a diet based on whole unprocessed foods would be disproved eventually. For example, CMP’s told us that enriched white bread was just as good as whole grain and that taking vitamins just gave people “expensive urine.” Now whole grains are highly espoused over refined flours, and multivitamins, well, the controversy over them continues.
But natural therapeutics was not a passing phase. As more and more people were helped with nutrition and other natural products, the popularity of dietary supplements has grown every year, along with all other categories of alternative care like acupuncture. According to a 2008 survey and analysis conducted by the Natural Marketing Institute, total sales in the health and wellness industry in just the U.S. alone was $112.3 BILLION dollars. While some CMP’s have contended that these are billion of dollars wasted, I have always asserted that people generally aren’t in a hurry to waste their money. In other words, if the products and services didn’t help them, consumers would not keep spending their money. And of course in clinical practice we can measure the results via lab results and other clinical measures such as body fat and blood pressure. More importantly we can track via questionnaires how a person feels and the changes they experience in their symptoms over time. This style of tracking outcomes is becoming very relevant in medical circles today.
Years ago, there weren’t nearly as many studies of different nutraceuticals or alternative therapies. Today, countless thousands of studies are proving the roles that many naturally-derived agents can play in health and disease management. Just look at the list – fish oil, folic acid, and vitamin D are all now regularly recommended by most doctors. In addition many doctors use niacin for dyslipidemia and B vitamins in the prescription form called Foltex for lowering homocysteine. Some of you may not remember it, but I remember when fish oil was decried along with all other nutritional products as “snake oil.” But over time research found that fish oil is needed to fight inflammation in the body and to help build healthy cell membranes. Because of these roles in the body, it helps reduce risk of heart disease, it helps mood, and can help relieve joint pain.
Vitamin D – was considered to be one of the riskiest fat soluble vitamins and we were taught that it could be toxic at as little as 4 x the RDA. Today we know that vitamin D levels are very low in most people possibly due to spending most of our time indoors, applying sunscreen when we are in the sun, and maybe even due to the cultural practice of daily bathing, which washes off the skin oils that contain vitamin D. Low levels are associated with increased risk for breast cancer, MS, and insulin resistance. Vitamin D supplementation is also being shown to protect people from the flu. Many MD’s are now testing their patients vitamin D levels and giving them vitamin D as necessary to restore them to more optimal levels. These are a just a few examples of nutritional therapies being integrated into conventional medicine.
Thousands of studies continue to be conducted and continue to validate the use of many nutritional therapies. Just look at the explosion of studies validating many positive effects from the use of different strains of probiotics. However, make no mistake, like all medicine, natural medicine is a work in progress, and as studies are conducted they change our understanding of many things. As the information has changed, we have changed. Not everything in natural therapeutics has turned out to be positive and still usable. For example, St John’s Wort is an herb that has been proven very effective in mild to moderate depression, however it was determined that this herb increases detoxification enzymes in the liver and therefore speeds up clearance of drugs such as oral contraceptives and many other drugs[i]. So, people on certain medications cannot use this herb; therefore it is not used as frequently as it once was. In addition, like all therapies, natural therapies need to be used with a full understanding of possible side effects. For example, while fish oil has tremendous value for prevention of heart disease, it can thin the blood and should be discontinued for several days before undergoing any surgery.
Natural therapeutics is a more holistic approach to health and has a better track record of considering all effects on health, such as effects from chemicals in the enviroment. This is another big change I have seen in regard to pesticides and other chemicals. In the 1980’s, industry was blissfully developing thousands of chemicals for all types of every day uses, and was telling us that the safety testing on animals proved them to be safe. Today we know that the single chemical testing looking only for development of cancers was not adequate. These studies tested the chemicals at the estimated amounts that “should” be in the environment instead of testing them at levels at which they actually occur. When tested in combinations and at levels that are really occurring in the environment, the studies found sexual changes, immune changes and endocrine disruption first in animals and now endocrine disruptions like insulin resistance and thyroid disruption are being seen in humans as well. Even the White House published a white paper regarding environmental chemicals.
Probably the biggest area of controversy in natural therapeutics is the use of different dietary supplements for specific and general health concerns. For example, natural and integrative practitioners have long recommended multivitamin and mineral supplements to help provide adequate levels of these nutrients, because of so many nutritionally inadequate foods on store shelves in Western countries. We were, and still are told that you can get all the nutrients you need from the diet. Yet, studies of foods have showed steadily declining nutrient levels over the last 50 years. Nutrition surveys like the NHANES studies continue to show that despite over consumption of calories, many Americans still take in less than RDA recommended amounts of some nutrients like zinc and magnesium. In the case of multivitamins, some studies show that the benefits outweigh risks and others have shown slightly increased health risks. Part of the reasons for disparate outcomes are the wide variety of multivitamins available. However, in the use of some dietary supplements it is perplexing when we ignore the known functions of nutrients in the body. For example, inadequate intakes of magnesium can affect heart rhythms and can create tight muscles, constricted blood vessels and is directly related to the development of high blood pressure and Type 2 diabetes. Yet conventional medicine almost never explores suboptimal intake of nutrients as a possible factor in these conditions. Chromium, a trace mineral known to be an essential co-factor for helping insulin to transport glucose into cells[ii] is another example. Extensive government research has identified chromium and the roles it can play in health, especially in better blood sugar regulation and therefore in healthier lipid profiles, yet it still is not incorporated into medical care for these issues. This is a whole area of needed study called, functional deficiencies, in which inadequate intakes of nutrients can create a problem, but doctors just haven’t been trained to consider a magnesium or chromium inadequacy in these chronic conditions.
In addition, many CMP’s seem to be unaware that there are literally tens of thousands of studies in peer-reviewed journals finding the effects of hundreds of different types of nutrients like CoQ10, magnesium, chromium, as well as extracts from herbs like Rhodiola and Holy Basil, and phytonutrients like Resveratrol. These studies elucidate effects, like lowering of blood pressure, lowered cortisol and blood sugar and even anti-cancer effects. It’s right there in the primary, peer reviewed literature, yet some CMP’s still believe these substances have no proven effects. Part of the confusion arises from seeing the headlines of studies that give the wrong impression. For example, one study a couple of years ago found that consumption of low dosages of vitamin C and synthetic vit E did not prevent heart disease [iii]. Well, anyone who knows nutrition knows that low dosages of two nutrients, especially the ineffective forms of the nutrients, will not reduce disease risks when nothing else in the diet or lifestyle is changed either. But the headlines read, “Antioxidants Don’t Lower Risk of Heart Disease” and that is the impression that sticks even though many studies would argue the conclusion of this sensational headline.
CMP’s often assert that supplements are dangerous and tainted. This contention is overblown, but true in some cases. The supplement industry is for the most part a group of manufacturers putting products on a store shelf that they intend to be safe. They have no interest in harming someone. The very fact that so few adverse events have occurred from nutritional supplements (especially compared to FDA approved prescription medicine) is also a testament to their safety record. However, there have been some incidents where sheisters simply out for a buck, have endangered consumers or at the very least misled them. In many cases these were internet sales, and the majority of the cases where supplements have been tainted involved ingredients from China and other foreign countries in which the ingredients suppliers spiked the material with medications or the manufacturing process did not eliminate solvents or check for pesticides.
It is up to manufacturers to test all raw ingredients and make sure they are not tainted with drugs or any other potentially harmful substances like lead. The reputable ones are already doing this and have for years. In addition, the industry has helped the FDA develop better, more stringent good manufacturing practices guidelines for dietary supplements and the FDA has been given more manpower to help enforce them. While some CMP’s want to throw out the baby with the bath water by outlawing supplements all together, consumers do not want to lose the right to purchase dietary supplements. EVERYONE wants safe supplements; the answer is to enforce supplement manufacturing safety guidelines and get rid of the companies who can’t or won’t follow the rules.
The Future of Supplements – Over time I have begun to see CMP’s who are starting to realize that some supplements do have health benefits. Many have seen the results first hand in their patients, realizing that to turn a blind eye was irresponsible. It would be easier to say, “it was just a coincidence” as many of their colleagues do, but they couldn’t. Many CMP’s are looking for better ways to practice medicine. They are frustrated because their only tools to help people in the past have been drug therapies which despite benefits, have many well-documented adverse events and the more drugs that are prescribed the greater the risk for a polypharmacy condition developing. In addition just like natural medicine practitioners are tired of unethical vitamin makers giving everyone a bad name, many CMP’s have become disillusioned with a pharmaceutical industry that too often has doctored clinical study outcomes or covered up negative outcomes to the detriment of the patients who trusted them. CMP’s do not like feeling like they have been the unwitting participants in harming their patients.
I want to be clear on my next point, modern drug therapy saves lives, but there are no magic bullets for chronic health conditions. The more that people refuse to take responsibility for their health, the more they will need drug therapy. Many CMP’s are as frustrated on this point as I am. They have too many patients that just want their doctor to be able to “fix them” with medicine, but for chronic conditions like diabetes and heart disease, lifestyle changes are crucial for better management of the condition. So many if not most CMP’s have come to realize that it just doesn’t work trying to treat lifestyle-related chronic conditions with drugs only. You have to address the cause of the disease to be most effective. These are the areas where nutritional supplements along with better lifestyle can shine.
I can honestly say I believe that in the not too distant future of health care, consumers will start to see more and more nutritional therapies being woven into their care by CMP’s. I believe this because I am involved in several projects that are already or will be training thousands of doctors on integrative care. I am extremely excited about the future of supplements because some manufacturers are finally doing everything it takes to provide pure and efficacious products. These are the manufacturers that CMP’s will use and this will take away product quality concerns. I also believe that in the future nutritional and other so –called natural therapeutics will no longer be looked at as “alternative”, but will instead just be looked at as good medicine. The biggest challenge in implementing healthier lifestyles and nutrition is getting patients from “knowing what to do” to “being able to do it. However as more and more medical practitioners start being given the education and tools to incorporate good nutrition and lifestyle advice into programs for their patients, it should get easier and easier to do, because there will be better resources to help support those efforts.
I am very happy and proud to have been a part of building integrative health care and look forward to the team at LMI and Integrative health Resources (my consulting company) pressing on to help it become all it should be. I have seen natural therapeutics as part of good integrative health programs change lives and I believe the future is very bright for this field. This has occurred because of many brave pioneers in research, manufacturing and practice, and especially you the consumers who have demanded this care.
I regularly refer to a famous quote by Nyles Bohr Quantum Physicist, “New Ideas Don’t Get Accepted, Old People Die.” Obviously, what he is saying is it takes time to allow new thoughts to penetrate our society. In this case we are trying to validate some of the old ways. Natural medicine was used in ancient cultures and still thrives in many countries like China and India. It was also the state of the art in the U.S. in the early 1900’s. One of the most cherished studies to me was the one a few years ago that showed that eating chicken soup really does help the common cold, proving that sometimes the old ways really do work! As research continues to validate different nutritional or plant based agents and other complementary therapies like massage and acupuncture, I believe natural medicine can and will play a valuable role in our future health paradigm, right along side the advances in modern medicine.