Recently one of my patients presented me with a print out of the information contained in the “Life Extension magazine” July 2007 issue entitled
“Reversing Atherosclerosis Naturally”
She asked me to read this because I had recommended statin (cholesterol lowering) medical therapy to her and she did not want to take statins but preferred a “natural” way to address her problem of advanced atherosclerosis.
My first reaction was to ask what the site was selling. At first she told me that she had not purchased anything from the site but it turns out she had purchased some of the snake oil that the site promoted in a very slick faux scientific way.
After looking at the document she presented me I concluded that Life Extension’s only goal is to convince naive searchers for “natural” methods of treating or preventing heart disease and aging that they should be taking something called glissading
The “article” begins with the following exciting pronouncement:
“Scientists have discovered a natural ingredient derived from a species of melon that has been shown to reverse signs of atherosclerosis in aging blood vessel walls. This nutritional supplement is able to boost levels of the body’s most powerful antioxidant defense enzyme, superoxide dismutase (SOD)”
The first sentence should be the tip-off for the reader that this is a site selling useless, unregulated yet expensive “nutraceuticals.” I could spend a thousand words (and minutes) convincing you that this supplement is useless but it is only one of hundreds of similar preparations, so my time would be wasted. Instead, let’s look at the problem in general.
The Allure of “Natural” Treatments
What attracts patients to use substances that are sold over the internet without any guarantee that they are effective, safe or that they even contain the “active” ingredients the promoters claim?
I really like Anthony Almdada’s description in his chapter in Nutraceutical And Functional Food Regulations In The US.
“The quest for “natural,” the drive to engage in “self-care” and the almost free and boundless access to the virtual, omniscient libraries called the Internet and social media messaging are forging a new breed of companies and consumers. Armed and dangerous with a modicum of evidence of simply a sugar-coated science tale, bioactives are birthed, brands are born, products are launched.”
Steven Novella (Science-Based Medicine) has written eloquently about the “plant vs pharmaceutical false dichotomy” here. He quotes the (Dr Oz featured) “Medicine Hunter,” Chris Kilham, as saying:
“my goal is to have more people using safe, effective, proven, healthful herbs, and fewer people using toxic, overly expensive, marginally effective, potentially lethal pharmaceutical drugs”
Kilham has created a forced choice or false dichotomy which would lead one to choose herbs over pharmaceuticals. In reality, the pharmaceutical drugs are the substances which have been proven safe and effective (having undergone rigorous trials in humans and an intense review process by the FDA) despite being manufactured by man. Herbs and nutraceuticals, despite coming from nature, are not proven to be either safe or effective.
“First and foremost, herbs and plants that are used for medicinal purposes are drugs – they are as much drugs as any manufactured pharmaceutical. A drug is any chemical or combination of chemicals that has biological activity within the body above and beyond their purely nutritional value. Herbs have little to no nutritional value, but they do contain various chemicals, some with biological activity. Herbs are drugs. The distinction between herbs and pharmaceuticals is therefore a false dichotomy.”
What Happens to a Plant-derived Substance That Proves Safe and Effective for a Medical Condition?
The simple answer is that it moves from the unregulated, over the counter, internet-marketed realm into the realm of being regulated by the FDA and prescribed by doctors.
A really great example of a botanical that became a useful pharmaceutical is digoxin.
Two hundred and fifty years ago, doctors had no FDA to help them choose safe and effective medications. They tried various, presumably medicinal, botanical preparations on their patients to see what worked.
Sometimes the patient got better, sometimes not.
Sometimes the patient got violently ill and died.
Since the doctors were only working on one patient at a time and did not have the luxury of large randomized trials to guide them, they could only guess whether the substance they had given their patient helped or hurt.
Through the wonders of the internet, you can download for free and read for yourself the experiences of one such doctor, William Withering, who was experimenting on his patients with a preparation made from the leaves of a plant with the Latin name of digitalis purpurea, more commonly known as foxglove.
He tried different ways of preparing it, sometimes using an infusion, sometimes a powder, and he tried different amounts on his patients. He recognized that the concentration of the active ingredient in the plant was different depending on the time of year, the growing conditions, and the part of the plant he utilized. There was no standardization of concentration available to him.
The only way he knew that he had given too much was when the patient’s pulse slowed too much or the patient vomited.
Over time, chemists and physiologists were able to identify the active chemical in foxglove, now called digitalis or digoxin, and produce it in a form that was pure and consistent.
According to GlaxoSmithKline, farmers in the Netherlands grow fields of woolly foxglove, which is a member of the snapdragon family. Bales of dried foxglove leaves are shipped to the U.S. Here, processing facilities macerate the leaves and extract digitalis using an aqueous-alcohol solvent. Further treatment and processing yields powdered digoxin, which is compounded into tablets, injectable solutions, elixirs, and capsules. It takes about 1,000 kg of dried foxglove leaves to make 1 kg of pure digoxin, the company adds.
Cardiologists are still using digoxin, primarily to slow the heart rate in patients with atrial fibrillation and to a lesser extent, to help patients with congestive heart failure.
We use less of it than we did 50 years ago because of the development of synthetic drugs, which are more effective for these conditions.
In addition, digoxin has what we term a narrow therapeutic window; even when we use precisely formulated pills, we can sometimes run into the problems from side effects that William Withering saw 250 years ago using foxglove leaves: slow pulse, vomiting and life-threatening abnormal heart rhythms.
To my patients who are attracted to internet-marketed, non FDA-regulated “natural” cures for aging and atherosclerosis I say: Take these substances at your own risk, they have been proven neither safe nor effective.
Although it is wise to be cynical and skeptical of drugs that are researched and heavily marketed by big pharmaceutical companies, at least we have the reassurance that they have all gone through a rigorous process of testing for both safety and efficacy, and that the pills we put in our mouths contain a precise amount of the active ingredient without any contaminants or unknown ingredients.