The Pill Book Guide to Natural Medicines: Vitamins, Minerals, Nutritional Supplements, Herbs, and Other Natural Products
By Michael Murray, N.D.
Natural Medicine Today
According to the 1999 Gallup Study of Vitamin Use in the United States, nearly one out of two adults (48 percent) now report current use of nutritional supplements, with 42 percent of the adult population taking three or more supplements daily. These numbers have increased by a third since 1993. Today, vast amounts of information on natural products are available from a variety of sources. But how reliable is this information? And even with the best information, consumers are often confused about how to make the best choices. This book is designed to make the process easier by providing answers to the key questions consumers have about the proper use of natural products. This book will provide you with the facts about the role of natural products in promoting health for you and your family. You'll find answers to help guide you to the proper use of products in the prevention and treatment of over one hundred common health conditions, from acne to varicose veins.
The Science of Natural Medicine
You may have noticed the designation N.D. after my name. The N.D. signifies that I am a naturopathic doctor. I am a graduate of Bastyr University in Seattle, Washington, and licensed in the State of Washington as a primary care physician. Naturopathic medicine is a system of medicine that emphasizes the use of natural, nontoxic therapies to prevent and treat disease and to promote optimal health. The scope of practice of an N.D. includes all aspects of family and primary care, from pediatrics to geriatrics, as well as the full range of human health conditions, including cancer. The natural products described in this book are the medicines that many naturopathic physicians rely on.
It occurred to me very early on in my educational process that if natural medicines are truly effective, their value should be evident in well-designed clinical studies. With that in mind I began a data-gathering process that continues to this day. Over the past twenty-plus years I have collected over fifty thousand articles from medical journals and other scientific literature that provide strong evidence of the effectiveness of diet, vitamins, minerals, glandular extracts, herbs, and other natural measures in the maintenance of health and the treatment of disease. It is from this constantly expanding database that I base my recommendations on health and healing. This database is also the basis for the rating scales for effectiveness and safety that are a prominent feature of this book. (See "How to Use This Book" for a complete explanation of the criteria.)
It gives me a sense of great pride that I have played a significant role in bringing many safe and effective natural products to America, including:
- Ginkgo biloba extract
- Glucosamine sulfate
- Silymarin (milk thistle extract)
- Enteric-coated peppermint oil
- Saw palmetto berry extract
These natural products are now household names because of their ability to make a difference in the health of the people who take them. They are prime examples of natural products whose efficacy is clearly demonstrated by solid, clinically based evidence. Unfortunately, not all natural products have the level of scientific and clinical support that these products have. And not all natural products are safe and effective.
When people refer to me as an expert in "alternative medicine," I usually correct them. I am a proponent of what I like to refer to as "rational medicine," which combines the best of both conventional medicine and alternative methods. We have all been helped by the wonders of modern, high-tech medicine. It can make a life-or-death difference when heroic measures are needed. As far as improving our general level of health, however, I believe it is woefully deficient.
Modern medicine fails us most in the treatment of chronic degenerative diseases such as heart disease, high blood pressure, arthritis, and diabetes. In many diseases, the natural approach is simply a much more rational approach. Rather than relying on drugs and surgery to suppress symptoms, I believe it makes more sense to use natural, noninvasive techniques whenever possible to promote health and healing - especially when studies indicate that adverse reactions to conventional medicines may be the fourth leading cause of death in America.
Using Natural Products as "Drug Substitutes"
To illustrate the use of natural products as an alternative to drugs, let's take a look at the use of glucosamine sulfate versus the drug approach to osteoarthritis - the most common form of arthritis. Osteoarthritis is characterized by a breakdown of cartilage. Cartilage plays an important role in joint function. Its gel-like nature protects the ends of joints by acting as a shock absorber. When this cartilage degenerates, it causes inflammation, pain, deformity, and limitation of motion in the joint.
The primary drugs used to treat osteoarthritis are the nonsteroidal anti-inflammatory drugs, or NSAIDs, including aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and diclofenac (Voltaren). These drugs are used extensively in the United States, but research indicates that while they may produce short-term benefits in the treatment of osteoarthritis, some of these drugs actually accelerate the progression of joint destruction and cause more problems down the road. NSAIDs are also associated with side effects such as gastrointestinal upset, headaches, and dizziness.
Simply stated, aspirin and other NSAIDs are designed to fight disease rather than promote health. Glucosamine sulfate, on the other hand, works by stimulating the manufacture of key cartilage components responsible for the shock-absorbing qualities of cartilage. The use of glucosamine sulfate in the treatment of osteoarthritis is consistent with the philosophy and practice of naturopathic medicine because of its action in facilitating the body's natural healing process. The clinical benefits of treating osteoarthritis with glucosamine sulfate are impressive. In head-to-head comparison studies, glucosamine sulfate has been shown to provide greater benefit than NSAIDs and to do so without any significant side effects.
The treatment of osteoarthritis with glucosamine sulfate is just one example in which a more natural approach produces better results and does so without side effects. Frankly, in my opinion it is a more rational approach than the drug approach.
Complementary Aspects of Naturopathic Medicine
In addition to being used as primary therapy, natural products are often useful as a complement to conventional medications. This situation is especially true with serious illnesses that require prescription drug and/or surgical treatments, such as cancer, angina, congestive heart failure, Parkinson's disease, and trauma. For example, a patient who has severe congestive heart failure that requires such drugs as digoxin and furosemide can benefit from the appropriate use of thiamin, carnitine, and coenzyme Q10 supplementation. Although there are double-blind studies demonstrating the value of these agents as complementary therapies in congestive heart failure, they are rarely prescribed by conventional medical doctors in the United States.
Natural Medicine Goes Mainstream
The astonishing increase in the popularity of natural products has several explanations. First, increased scientific investigation into the importance of nutrition and the value of antioxidant nutrients such as vitamins E and C led to more credible information on the value of nutritional supplementation. This information was well accepted by the early devotees of nutritional supplementation. Initially, demographic studies of supplement users indicated that they tended to be better educated and have a higher social status than nonusers. That is no longer the case, as more and more people from all walks of life have begun to use vitamin C to ward off a cold and vitamin E to possibly prevent heart disease.
The next major development was the tremendous influx into North America in the 1980s and early 1990s of high-quality products that actually produced noticeable results. Many of these products, such as Ginkgo biloba extract, St. John's wort extract, and glucosamine sulfate, carried with them significant scientific documentation of their safety and efficacy, leading to even greater credibility and acceptance.
Perhaps the biggest reason for the tremendous explosion in popularity for many products, however, occurred in 1994 when Congress passed the Dietary Supplement Health and Education Act (DSHEA). This landmark bill was the result of tremendous support from the American public. In passing DSHEA, Congress recognized that many people believe dietary supplements offer health benefits and that consumers want a greater opportunity to determine whether supplements may help them.
DSHEA essentially gave dietary supplement manufacturers freedom to market more products as dietary supplements and to provide information about their products' health-promoting benefits. Under DSHEA, the Food and Drug Administration (FDA) is still responsible for overseeing the supplement industry and the truthfulness of the claims that are being made. In addition, the Federal Trade Commission (FTC) regulates the advertising of dietary supplements.
How Natural Products Are Regulated
As with any food product, federal law requires manufacturers of dietary supplements to ensure that the products they put on the market are safe. It is the FDA's responsibility to police the safety of nutritional supplements. But under DSHEA, once a dietary supplement is marketed, the FDA has the responsibility for showing that a dietary supplement is unsafe before it can take action to restrict the product's use or take it off the market. In regard to supervising label claims, in response to DSHEA, the FDA instituted new requirements for the product labels of dietary supplements. All natural products that fall under DSHEA must meet these label requirements.
The FDA's Requirements for Dietary Supplement Labels
Information that is required on the labels of dietary supplements includes:
Statement of identity (e.g., "ginseng").
Net quantity of contents (e.g., "60 capsules").
Structure-function claim (e.g., "promotes joint health") and the statement "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."
Directions for use (e.g., "take one capsule daily").
Supplement Facts panel (lists serving size, amount, and active ingredient[s]).
Other ingredients in descending order of predominance and by common name or proprietary blend.
Name and place of business of manufacturer, packer, or distributor. This information provides the address to write to for more product information.
The Limit of the Health Claims
What separates a dietary supplement from a drug is that a dietary supplement must not make a claim to treat, cure, or prevent disease even if it is obviously true that it does. For example, it is generally accepted in even the most conservative medical circles that vitamin E supplementation helps to prevent heart disease, that vitamin C can reduce the severity and duration of the common cold, and that Ginkgo biloba extract is quite helpful in treating cerebral vascular insufficiency (decreased blood supply to the brain). Even though these statements are true, a manufacturer may not put them on a label. To do so would constitute a drug claim. A product sold as a dietary supplement and touted in its labeling as a new treatment or cure for a specific disease or condition would be considered an unapproved - and thus illegal - drug. Labeling changes consistent with the provisions in DSHEA would be required to maintain the product's status as a dietary supplement. In the case of vitamin E, for example, under DSHEA a manufacturer could say only that vitamin E is necessary for proper heart and vascular function.
DSHEA allows supplement manufacturers to use claims referring to the supplement's effect on the body's structure or function, including its overall effect on a person's well-being. These are known as structure-function claims. Examples of structure-function claims are:
- Calcium builds strong bones.
- Antioxidants maintain cell integrity.
- Fiber maintains bowel regularity.
Manufacturers can use structure-function claims without FDA authorization, but like all label claims, structure-function claims must be true and not misleading. Otherwise the FDA or FTC will step in. Structure-function claims can be easy to spot because, on the label, they must be accompanied with the disclaimer "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."
Manufacturers who plan to use a structure-function claim on a particular product must inform the FDA of the use of the claim no later than thirty days after the product is first marketed. While the manufacturer must be able to substantiate its claim, it does not have to share the substantiation with the FDA or make it publicly available. If the submitted claims promote the products as drugs instead of supplements, the FDA can advise the manufacturer to change or delete the claim.
The Goal of This Book
Obviously the current situation regarding label claims and intended uses of natural products is less than ideal. There is a tremendous gap between the usefulness, safety, and effectiveness of many products and what the manufacturer is able to tell consumers. My goal in this book is to set the record straight on the value of virtually every natural product on the marketplace. As a person who has dedicated his life to understanding how these products work, both in my clinical practice and through my ongoing involvement in the natural products industry, I know firsthand the relative merits of a particular natural product compared to conventional drugs, and also how it compares to other natural products.
I am such a strong advocate of responsible self-care with natural products because I know they can make a huge difference in the quality of life of people who take them. I want to see the natural health movement flourish, and I believe the best way that I can contribute to this movement is for people to get real, positive results when they use natural products. I believe in the healing power of nature and natural products, but that power is available only if you use the right product for the right indication at the right dosage. All of the information in this book is meant to ensure that you have a good experience with natural medicine.
This book does not tell you which brand of a particular product to buy. Branded products are profiled individually only when they represent a special formulation or combination of substances. Other brand names are mentioned within the profiles when a brand has a substantial amount of original scientific research behind it or has established a dominant position through marketing and/or unique features. Compared to over-the-counter and prescription drugs, there are relatively few unique branded products within the natural products category. This constitutes one of the key differences between the pharmaceutical world and the natural products industry. Drug companies invest huge sums of money to create the required research support for their products. (It is estimated that achieving FDA approval for a new drug costs in excess of $300 million.) They spend even more money marketing their brand names. They can afford to make the investment because they have been granted patent protection for their product-exclusive rights to manufacture and sell it for a given number of years. Only after the patent has expired are generic versions made available, usually at much lower prices. However, a natural compound per se cannot be patented. Extraction or manufacturing techniques, and sometimes the use of a natural product for a specific application, may be patented, but not a naturally occurring plant, vitamin, or mineral.
Because of the lack of patent protection, when a particular manufacturer does invest in clinical research on a natural substance, it is often co-opted by other manufacturers to promote the sale of their knockoff product - which may or may not be identical to what was used in the study. In the supplement industry this is referred to as "borrowed science." For example, let's take one of the most popular natural products in North America, glucosamine sulfate. All of the clinical research on glucosamine sulfate was conducted using a compound developed by Rotta Pharmaceuticals of Milan, Italy. The Rotta product is available in the United States, but it is priced substantially higher than generic glucosamine sulfate.
Most physicians and pharmacists allow for generic substitutions for branded prescription drugs because a generic drug is legally required to contain the same level of the active ingredient as the branded drug. Theoretically, the same should be true for natural products, but quality control standards are still a problem within the natural products industry. For example, in December 1999 and January 2000 ConsumerLab.com purchased a total of twenty-five brands of glucosamine, chondroitin, and combined glucosamine/chondroitin products. These products were then tested to determine whether they contained the amounts of glucosamine and/or chondroitin stated on the label. Nearly one-third of the products tested did not pass.
Although I do not recommend particular brands, I can offer you a rule of thumb in making your purchases: Buy from respected manufacturers that employ good manufacturing practices (GMP). A manufacturer that follows FDA (or HPB in Canada) guidelines for GMP for a drug manufacturing facility is the most likely to have a higher-quality product. In general, if one product is substantially cheaper than a seemingly identical product, buy the more expensive one. With nutritional and herbal products (as with many other things), you get what you pay for. Companies that follow appropriate GMP and have their own quality control laboratory will have higher overhead than manufacturers who do not follow GMP; as a result, they will have to charge more for their product.
In an effort to establish quality control standards for the supplement industry, the National Nutritional Foods Association (see www.nnfa.org) - the largest trade association in the natural products industry - is in the process of developing its own set of standards for GMP. The NNFA program currently in place, the TruLabel program, has been extremely successful. Members of the NNFA who manufacture dietary supplements and herbs under their own label are required to be members of NNFA's TruLabel program. More than seventeen thousand product labels are currently registered as part of the TruLabel program, the industry's most expansive and successful self-regulatory program. Since 1990, NNFA's TruLabel program has garnered national and international respect by promoting quality assurance, safety, and guideline compliance to dietary supplement suppliers.
With the use of natural products for self-care comes personal responsibility. Here are some important points to consider:
Although this book discusses the use of natural products for numerous health conditions, it is not intended as a substitute for appropriate medical care.
If you wish to try a nutritional supplement or herbal product as a therapeutic measure, discuss it with your physician first, especially if you are taking any prescription medication. Doing so can help avoid potential side effects and adverse interactions.
Do not self-diagnose. Proper medical care is critical to good health. If you have symptoms that suggest an illness described in this book, please consult a physician or health care provider immediately.
If you are currently taking a prescription medication, you absolutely must work with your doctor before discontinuing any drug or altering any drug regimen.
Make sure your physician and pharmacist are aware of all the nutritional supplements or herbal products you are currently taking.
Many nutritional supplements and herbal products are effective on their own, but they work best when they are used as part of a comprehensive natural approach to health that incorporates diet and lifestyle factors.
Michael T. Murray, N.D.