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Ask the Doctor Why and Which Vitamin & Herbal Supplements are Important

Question:
If there is scientific information on using vitamins and herbs in medicine, why don't all doctors do more of this?

Answer:
Good question! I wonder that myself sometimes. The answers I have postulated fall into these main areas: Training In medical school, learning is likened to 'catching paint with a screen door'. This means that the information comes in faster than it can be assimilated. Doctors subconsciously realize a few things: knowing the material is critical, knowing it all is not probable.

To compensate for the fear of not being competent enough, we often take on a reactionary attitude of infallibility. Along with this comes a belief that anything they didn't learn was not relevant. Therefore, any methods they were not exposed to could not have much merit. Medical doctors are specialists in pharmacology and surgery. The problem is that these specialists assume that their areas of expertise are the only ones relevant. Since they are not trained in areas of lifestyle management or botanical medicine, they don't realize the merits of other approaches. More evolved doctors realize their own limitations and don't castigate areas outside of their knowledge.

Economics

In America, medicines are patented. Much money is spent for approval studies, which is later recouped by tagging the cost of research onto the drug. In order to prevent a competitor, who does not have the burden of research expenses to cover, from undercutting your cost, you patent and monopolize the drug's sale. In America, this model does not work for medicines with a molecular basis in nature. Nutrients, botanical medicines, even hormones can't be patented. Consequently, there is no incentive to finance approval studies for natural medicine. One could never recoup the initial testing costs without fear of being undercut on prices. This directs research dollars to medicines with molecular forms not found in nature. Interestingly enough, the distinction here is not between natural and synthetic. There is nothing natural about compounded Estradiol, for example. It is synthesized in a lab, using methods not found in nature. Since it is molecularly identical to Estradiol made in our bodies, it can't be patented.

Safety Studies

A common objection to natural medicine given by conventional doctors is that many items have not been adequately researched. One of the biggest areas of research gaps in in the area of long term safety studies. The reasons more of these are not done were in the last section. These are usually done when approval is hoped for. The current model for safety is from the pharmacology model. Doctors have seen over and over where many times a drug comes out full of hope and promise, only to have severe side effects show up after it is in use for awhile. From this experience they become wary of new therapies in general. For example, if you were a doctor in 1985 and were digging in the literature, you may have learned that folic acid seems to prevent neural tube defects

Alas, sounds good, but where are the safety studies? If you dug harder, you would have found that folic acid at dosages needed to prevent neural tube defects had been used by pregnant women in the past without incident. When potential benefits to a therapy is high, and side effect possibilities are minimal (as with vitamins, minerals and most herbs) it is medically appropriate to be willing to use therapies based on potential benefit.

Many physicians reasoned that if: folic acid may prevent some birth defects, it has no risks at dosages needed to possibly do so, the cost is minimal, why not recommend it while we are waiting to learn more? Doctors stuck in the reactionary new drug=side effects mode automatically rejected this stance. Some researchers estimated that over 200,000 cases of neural tube defects could have been prevented if doctors didn't wait so long to recommend it. Much of natural medicine is similar. Studies showing possible benefits have been done.

When therapies offer no harm and much possible benefit, why not give them a chance before those with definite harm?

Dr. Alan Christianson

Dietary change can prevent many cancers

WESTPORT, Dec 11 (Reuters Health) - Diets high in fruits and vegetables and low in meat are protective against breast, prostate, bowel and other cancers, according to a report in the December 12th issue of the British Medical Journal. Drs. John H. Cummings and Sheila A. Bingham of the MRC Dunn Clinical Nutrition Center in Cambridge, UK, reviewed the findings of "...two reports, one from the Chief Medical Officer's Committee on Medical Aspects of Food (COMA) and one commissioned by the World Cancer Research Fund."

"What is remarkable about the diet-cancer story," they write, "is the consistency with which certain foods emerge as important in reducing risks across the range of cancers." Increased consumption of fruits, vegetables is "...almost invariably protective for the major cancers...," they conclude, while the consumption of meat, especially red and processed meats, "...is linked with higher risk of bowel, breast, prostate and pancreatic cancer." Drs. Cummings and Bingham conclude that the adoption of a cancer-protective diet may also be "...a good prophylactic for preventing many chronic diseases of lifestyle."

According to the two experts, other cancer risk factors include exposure to direct sunlight, sedentary lifestyle, smoking, sexual promiscuity, overweight and excess consumption of alcohol.

BMJ 1998;317:1636-1640.

Bone density screening may be advisable starting at age 21

CHICAGO, Dec 10 (Reuters Health) - Population-based studies indicate a much higher-than-expected rate of osteopenia and osteoporosis among postmenopausal women. The findings are significant enough for one San Diego radiologist to recommend bone mineral density screening for many women when they are between the ages of 21 and 35. Dr. David J. Sartoris, of the University of California at San Diego, told meeting participants at the 84th Scientific Assembly of the Radiological Society of North America that the key to eradication of osteoporosis--a goal of the Society within the next century--is early detection and prevention. "Women at risk are wasting 20 years of potential intervention by waiting until menopause to find the disease," he told conference attendees. "We're starting to think of osteoporosis not as a disease of older women, but as a pediatric disease, because that's when the problem frequently starts. Most children don't get enough calcium or physical activity...They're already in trouble by age 30." Dr. Christopher Cann, of the University of California at San Francisco, who sat on a special focus panel on osteoporosis with Dr. Sartoris, told Reuters Health that his approach is somewhat less aggressive than the protocol recommended by Dr. Sartoris.

Dr. Cann recommends early screening of patients with known risk factors for osteoporosis such as a family history of the condition. "This goes for men as well as women," he pointed out. In addition, Dr. Cann said that individuals with a history of eating disorders, women who have exercised to the point of amenorrhea during puberty or early adulthood and women who have a history of delayed puberty might all, on the basis of a physical exam at age 25, benefit from bone mineral density measurement at that time. "If you have an objective measure, that really improves the compliance..." with recommendations for adequate calcium intake, physical exercise and other lifestyle modifications, Dr. Cann noted. In younger patients, either a central or a peripheral reading of bone density is acceptable, Dr. Cann said. In older patients, "...the recommendations for central measurements are fairly strong when you're trying to look at the effects of therapy on bone change rapidly."

Copyright 1998 Reuters Limited.

Study Links Low Zinc Intake To Heart Disease, Diabetes

December 10, 1998 01:31 PM PST NEW YORK, Dec 10 (NYT Syndicate) - Studies have already indicated that a lack of zinc in the diet may retard growth, slow wound healing and weaken the immune system. Now a study from India suggests that deficiencies of the trace mineral may also put people at greater risk for heart disease and diabetes. Among 3,575 rural and urban adults in northern India, lead researcher Dr. Ram Singh of the Center of Nutrition and Heart Research Laboratory in Moradabad found that those who consumed less than 7 milligrams per day of zinc were more likely to suffer from diabetes. City residents who ate less zinc also showed higher rates of heart disease. The recommended daily allowance of zinc is 8 to 11 milligrams per day for adults. Compared to those in rural areas, urban Indians tend to eat more meat, fish, eggs and milk products, foods associated with higher cholesterol and blood-pressure risks but also with high zinc content. Yet one in three urban residents in the study had diets low in zinc, meaning less than 7 milligrams daily, compared with one out of every four rural residents.

According to Singh's study, which is published in December's issue of the Journal of the American College of Nutrition, urban Indians may eat less zinc because they have replaced basic grains such as millet with refined cereals. This is not the first study to suggest a link between zinc consumption and heart disease or diabetes, but it examines a particularly large cross-section of subjects, according to Dr. Harry Preuss of Georgetown University in Washington, D.C. The next step, he said, would be for the researchers to give subjects zinc supplements to find out whether zinc deficiencies contribute to their ailments. ``Certainly it's worth a try because it's harmless to do it,'' said Preuss. ``Zinc would be fairly safe, up to a limit.'' While people in developing nations suffer more severe zinc deficiences than those in Western countries, the problem has generated numerous studies in the United States as well.

One primate study done at the University of California, published in 1996, suggested that a lack of zinc can retard bone growth in adolescents, possibly threatening girls with osteoporosis later in life. In 1995, a study at the University of Alabama showed that zinc supplements boosted birth weights of African-American babies whose mothers had low levels of zinc. In an editorial accompanying the articles, Dr. Ananda Prasad of the University Health Center in Detroit called for international health organizations to remedy zinc deficiencies around the world, both in developing and developed nations. ``There are severe adverse consequences to health related to zinc deficiency, however, it continues to remain a neglected problem,'' Prasad wrote. ``We can only hope that some day this is corrected.''