TO YOUR HEALTH: Natural is Neutral
Whether a treatment is natural is less important than if it's safe, effective, and affordable.
By Dr. Joseph Ferguson
GUEST COLUMNIST
Editor’s Note: These columns by local medical professionals offer insights and advice on a range of medical topics. The opinions or views expressed in these columns are not intended to treat or diagnose; nor are they meant to replace the treatment and care that you may be receiving from a licensed professional physician or mental health professional.
Hucksters selling useless medical treatments love to say that their treatments are “natural.”
What do people mean when they say that a treatment is natural? For the purposes of this article, I will define a natural treatment as one where either there is no ingestion of any substance or, if a substance is ingested, the substance is one found in nature, not one that has been synthesized in a factory.
So what is the value of a treatment being natural? The reality is that whether a treatment is natural is neither good nor bad. It is neutral.
Medical decisions are shared; they are a collaboration between the patient and the medical provider. There are only three relevant considerations when deciding whether a biologically active substance should go into a person’s body, or whether any form of a treatment plan should be initiated: what are the positives, negatives and monetary costs? In other words:
Is the treatment likely to do what it’s supposed to do, to cause significant benefit, and is the goal of treatment important enough to merit treatment?
Are there downsides to the treatment? For example, does the treatment cause unwanted side effects like weight gain?
What are the financial issues? If a treatment costs $1,000 out-of-pocket every month and you don’t have that kind of money, then why are we even talking about it?
Arsenic, hemlock and poisonous mushrooms are all natural and all three of them can kill you. Does the fact that those three substances are natural somehow make them fit for human consumption?
In my medical practice, I recommend natural treatments all day long. In fact, when I see a new patient, there is a great likelihood that I will recommend a new natural treatment. It is my impression that I recommend natural treatments at a much greater rate than most physicians.
But natural is still neutral to me. I never recommend a treatment plan because it is natural. I recommend certain natural treatments purely because those treatments are safe, effective and affordable.
Increased exercise, a high-fiber and low processed food diet, supplemental fiber and increased water intake are all incredibly safe and effective in the treatment of both the diarrhea and the constipation that can be present in irritable bowel syndrome.
In many people, the best treatment for high blood pressure is not medication. It’s exercise, sodium restriction, caloric restriction and weight loss. Lifestyle change is extraordinarily difficult. That’s why some people don’t do it. I’m not just a coach trying to point in what I see as a helpful direction. I’m also a teammate, a cheerleader, a counselor and an educator. Even if I have to put you on medication for your blood pressure, the push never stops to use lifestyle change, often including weight loss, as a way to get you off the medication.
Vitamin D supplements can be very effective in both the treatment and prevention of osteoporosis. An ideal level of vitamin D in the blood appears in some studies to be associated with the proper functioning of the immune system, which could help not just in the prevention of infectious disease, but could reduce the risk of autoimmune disease and cancer.
Melatonin is a hormone found in humans and other creatures. It appears to play a role in the regulation of sleep and wake cycles. Melatonin is safe and can be effective in the treatment of occasional insomnia.
Counseling is often effective in psychological illness, and it can work better than psychoactive medication. Even when psychoactive medications are prescribed, counseling is almost always a good complement to those medications.
The list goes on and on. Natural treatments are often the best. But they are best because they are safe, effective and affordable, not because they are natural.
A Natural Is Neutral Case Study
To understand the specific decisions that are made when one has internalized my belief that “natural is neutral,” let’s examine my approach to patients with long-term severe constipation.
Most treatments for constipation fit into one of these four categories:
Stool softeners, most of which are not particularly effective and should probably be avoided for that reason
Stimulant laxatives, which are sometimes problematic because of a potential increased risk of abdominal cramping; they should never be used for more than a week at a time, because intestines can become dependent on them
Bulk laxatives, which are fiber supplements; they are effective and safe for daily use
Osmotic laxatives, like Miralax, Milk of Magnesia and prune juice. The latter two are safe for daily use.
I mention daily use because it is the cornerstone of my approach to patients with longstanding severe constipation. The goal of treatment is to take someone whose daily life is a hell caused by constipation, and to make their life similar to someone who never has any issue of any kind with their bowel movements.
Drinking lots of water is essential. Drink enough water so that your urine has very little yellow. If you allow yourself to become dehydrated, the daily regimen I’m about to describe is possibly going to cause you to have abdominal cramping. Also, eating a high-fiber diet, with greatly reduced processed food, is very helpful for reducing constipation, as is plenty of exercise.
The daily regimen is composed of one, two or three of the following: fiber supplements, Milk of Magnesia (which is just a magnesium supplement), and prune juice. A lot of the time, people get best results with a combination of the three, but for some people, the secret sauce is a very specific dose of just one or two of them. Start with low doses and increase or decrease the doses depending on the effect. It might take a few weeks, but eventually you will likely find the perfect cocktail. You are to take it every day, maybe for the rest of your life, continuing to adjust doses upward and downward as necessary.
Prune juice has a high concentration of a carbohydrate called sorbitol. It is poorly absorbed in the small intestine so a large portion of it makes it into the large intestine where it draws in fluid through a process called osmosis. That fluid in the large intestine acts like a gentle enema from above.
Milk of Magnesia is also an osmotic laxative. It is formulated in such a way that a large portion of the magnesium in Milk of Magnesia makes it to the large intestine where it draws in fluid.
If you are taking Milk of Magnesia every day, we will follow the magnesium level in your blood. In the very unlikely event that your magnesium level gets too high, we will decrease the dose. In general, blood levels of magnesium that are on the high end of the ideal range are probably a good thing, as they have been associated with stronger bones, more regular heart rhythms and muscles that are less likely to cramp. Daily Milk of Magnesia definitely helps people to have a magnesium level in their blood that is on the high end of the ideal range.
Miralax is also an osmotic laxative, so it acts as a gentle enema from above. It is extremely safe for short-term use. I only rarely prescribe it because I like the side benefits of Milk of Magnesia so much, but I do believe that Miralax is a fantastic short-term treatment for constipation.
Believe it or not, Miralax is polyethylene glycol, which means it is composed of ethylene glycol units connected together. Yes, Miralax is synthesized in a factory using ethylene glycol, a compound that is the primary component of many products sold as antifreeze and brake fluid! Talk about an unnatural medication!
But when compounds bind together, their effects in the human body are so different that the effects of the constituent parts are often irrelevant.
Chlorine is toxic and can kill you. Is that fact relevant when considering the toxicity of the compound that results when sodium and chlorine bind together? No, the toxicity of chlorine is not relevant when determining the possible toxicity of table salt, sodium chloride.
In the same manner, even though drinking antifreeze or brake fluid could kill you, it turns out that the toxicity of ethylene glycol is probably irrelevant when determining the toxicity of polyethylene glycol, Miralax, which ends up being one of the safest short-term medications that you could possibly take.
Imagine I’m seeing a patient for constipation. When I first saw this person last week, I made all my usual recommendations. I asked the person to increase their exercise; I started them on increased water; I put them on a high fiber and reduced processed food diet; and I started them on my typical three daily supplements. The individual has taken steps toward following all my recommendations, but she started out with tiny doses of the three supplements and hasn’t seen much benefit yet.
Saying they are still miserable, they went to a pharmacy and bought two different medications for constipation, and wants to try one of them.
The person bought Miralax and senna, a stimulant laxative derived from a beautiful flowering plant. Senna is the poster-child for being all-natural. But stimulant laxatives can be toxic and are rarely necessary. This person’s best bet is to try the Miralax because it is likely to be effective and, even if they have to use high doses, it is less likely than a stimulant laxative will cause abdominal cramping.
So in this case, the safe, effective, and gentle treatment is the stuff synthesized in a factory using antifreeze, not the stuff derived from a beautiful plant.
When a person selling a medical treatment emphasizes that the treatment is natural, alarm bells should go off. I’m not saying that the person is a huckster. I’m just saying that the person deserves very close scrutiny.
So go ahead and gravitate toward natural treatments. But only take the natural path when it is safe, effective and affordable. Use your common sense and don’t use natural treatments just because they are natural.
Joseph Ferguson, MD, is a graduate of The John’s Hopkins School of Medicine. He founded Fredericksburg Primary Care 20 years ago and he has operated that clinic ever since.
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