Many patients are interested in the concept of using supplemental agents such as herbs or vitamins to enhance their health and prolong their life. Indeed, we all wish to be as healthy as possible. Television ads, Internet promotions, herb stores, and countless books and articles bombard us daily with the alleged benefit of "this" pill or "that" product.
First, there is no doubt that many of our best medications have herbal origins. Aspirin comes from willow bark. Digoxin originates with the digitalis plant. Until the 1960’s, digoxin was administered by dispensing bottles of leaves from the digitalis plant and telling patients to chew the leaf until they felt nausea (a toxic side effect). This all lends a ring of truth to the claims many make about herbal and “all-natural” cures. A working knowledge of herbs was an important part of medical care long before we learned how to analyze and test specific ingredients.
However, things are never as simple as they seem. Pharmaceutical companies have been accused of hiding miracle cures for the sake of profit. Perhaps the companies have made occasional mistakes, but bear in mind they also have brought us truly great treatments for many diseases. Many of these discoveries were built on “natural” foundations. In the case of aspirin and digoxin, once the active ingredients were identified, the companies refined and standardized the dosing so that we could much more effectively administer the medication. Even today, research goes on to determine what is useful and what is not. A recent example involves glucosamine chondroitin in the treatment of joint pain. When it was first marketed widely a few years ago, many of us were skeptical. Then data was developed suggesting that it could be helpful. Now studies are saying it probably does not help. The point is that drug companies have a vested interest in being the first to bring useful and safe products to market, not to suppress them.
Cynics will say profit motive and an unholy alliance between physicians and those “evil” drug companies keep “all-natural” products from being widely accepted by the mainstream medical community. My own cynicism questions why those making such charges are the ones making outrageous profit from selling unproven “cures” to gullible customers. I must confess that I am overtly offended by the underlying premise that we, as physicians, are somehow keeping secrets and suppressing “all-natural” treatments which could help our patients. Remember that rattlesnake venom and venom from brown recluse spiders are “all-natural” compounds, too, but they are anything other than safe.
The claim that a treatment is good because it is “all-natural” is a dangerous and misleading sales pitch. Still, patients are often more confident in the opinions of their friends and relatives and the teenager behind the counter at the herb store than they are in proven scientific research.
In the absence of some other special disease consideration, my general advice to patients is simple. Eat a well-balanced diet, and you probably don’t need extra vitamins or herbs. If you feel you need to supplement your diet to get adequate vitamins and minerals, a good multivitamin has everything the average person needs. If you are going to take a vitamin, then it is worth using a brand name (Centrum Silver or Theragran-M, for example), to assure the best bioavailability of the individual ingredients. Avoid large doses of other individual vitamins such as B6, B12, C, E, etc. At best, you are wasting money, and at worst, you may actually cause harm. For instance vitamin A is toxic in large amounts, and vitamin E may be associated with increased cardiovascular risk. Check the RDA (recommended daily allowance) of each ingredient as listed on the label to be sure you the product you are considering meets your individual needs.
As in every other area of life, exceptions occur. We do suggest calcium and vitamin D to help postpone osteoporosis. There are some disease processes requiring supplementation of various vitamins. Vitamin B12 in the case of pernicious anemia comes to mind. Consult your physician about specific dietary requirements. Just don’t get fooled by the sales pitches of the merchants trying to separate you from your money. Ask yourself: Do you really think these people bought all that advertising time on television, in newspapers, and magazines, and rent high price real estate in malls because they have only your best interest in mind? Not likely! Follow the money.
Thomas L. Horton, MD