“Natural” Isn’t Always Better (But It Might Be)

More and more, parents are becoming vigilant about maintaining as “natural” of an environment as possible for their children. I get it. It seems like everywhere you look, your child is exposed to heavy metals, carcinogens, radiation, pesticides, and other potentially harmful substances. Those exposures are certainly not ideal, and avoiding them as much as possible is perfectly reasonable. The major concern I have with some efforts to pursue a “natural” lifestyle is the addition of supplements (which are usually unnecessary and also have potential to cause harm) in an attempt to promote health. When a child gets sick, this same philosophy carries over to treatment, and many parents avoid conventional pharmaceuticals in favor of more “natural” remedies such as herbs, supplements, or tinctures.

The problem with this approach is that the majority of these therapies are entirely unregulated. Because they aren’t categorized as medications, the FDA has no role in testing these products, either for safety or for efficacy. There is no guarantee that the manufacturer’s claims about how a supplement may help your child are true. There is also no guarantee that the “natural” product you give your child won’t hurt her. Additionally, many substances derived from plants vary in concentration depending on soil quality, rainfall amount, time of year, etc. You often don’t know exactly what you’re getting, how much of it you got, or what it’s going to do.

The internet is rife with anecdotes about how a particular supplement, diet, or other intervention cured or significantly improved someone’s medical condition. Maybe it did. Or maybe that person has another website where they sell that supplement. It could have been placebo effect, which is nearly always 30% effective, no matter what condition you study. Or maybe it truly helps 1 in 50 people, but only the ones that it helps bother to blog about it.

As a physician who attempts to practice conscientious medicine, I prefer to use and exhaust behavioral interventions and lifestyle modifications (or to simply allow a disease to run its course) before reaching for the prescription pad. But I’m also not quick to recommend the use of substances that haven’t been proven to be effective or even safe. While some supplements are now commonly used in mainstream medicine to treat or prevent various medical conditions (a few examples are coenzyme Q10, folic acid, niacin, calcium and vitamin D), these are used for individuals with specific conditions or known deficiencies after studies have shown that the benefits outweigh the risks.

As far as vitamin supplementation for children goes, the typical American diet provides nearly all the vitamins, nutrients, and minerals a child needs, without the need for supplementation. The one vitamin that is frequently found to be deficient is vitamin D (more so in individuals in northern climates, with dark skin, who are overweight, or who spend little time outdoors). This editorial, recently published in the Annals of Internal Medicine, discusses recent reviews of multiple studies that showed either no benefit or evidence of harm from numerous commonly used vitamins and supplements. (It’s about adults, but still…) No, I don’t think a Gummy Flintstone every morning will hurt your child, but it probably won’t help much either.

Why the Evil Pharmaceutical Companies May Not Be [Quite] As Evil As You Thought

Another reason many parents prefer “natural” therapies is that they don’t trust or don’t want to support the pharmaceutical industry (which many view as a capitalistic monster, just itching to inject your child with poison for the right price). I’ll concede that drug companies are driven by money. But what industry isn’t? Look at the iPhone in your pocket or the hybrid in your garage–where would they be if those companies had not been driven by profits? Innovation is driven by the potential for success. Without the prospect of making a fortune by developing the next miracle drug, there would be minimal progress in the field of medicine. It costs an insane amount of money to develop a new drug, perform the trials necessary to confirm its safety and efficacy, and get it approved and on the market.

Cystic fibrosis (CF) is an excellent example of how these developments can change lives. First described in 1938, CF is a genetic condition in which a cellular “gate” for salts doesn’t work properly. Because of this defect, fluids don’t flow through the cells as they should, which results in abnormally thick mucus that affects multiple body systems. The lungs are unable to move pollutants and bacteria upwards and out as they should; this leads to clogged off airways, chronic infections, and progressive (eventually fatal) decline in lung function. Other common problems include malnutrition, diabetes, and digestive problems. When CF was first recognized, it was uniformly fatal in early childhood. By 1962, the average life expectancy had risen to 10 years. Since then, we have identified over 1,000 different mutations that cause CF. We have also developed new classes of antibiotics, better ways to deliver those antibiotics where they are needed, and medications that break up the thick mucus. We have several devices that help to clear the mucus from the airways. One of the newer treatments for CF (for a specific mutation) helps those gates get where they need to go so they can do what they are supposed to do. There are gene therapies on the horizon that could provide all a person’s cells with a correct “blueprint” so that the gates they make would function correctly. Because of all this progress, the average lifespan of an individual with CF today is in the early 40’s, and it’s increasing all the time. Yes, there are some people who made a killing from these innovations, but I haven’t met a parent of a child with CF who minded the progress.

I should also mention that, as much as the drug companies are out to get your money, those who produce and sell supplements are as well. GNC had revenues of $2.63 billion last year. Somebody’s “Living Well.” This article from Forbes talks about the exploding industry of nutritional supplements:

“One of the fastest growing industries in the world is the nutritional supplement group, or more broadly known as Vitamins, Minerals and Supplements, or VMS. Producing about $32 billion in revenue for just nutritional supplements alone in 2012, it is projected to double that by topping $60 billion in 2021 according to the Nutritional Business Journal.”

Of course, those numbers pale in comparison to the revenues from pharmaceutical companies, but they also don’t have to overcome the enormous expenses of drug development and testing before turning a profit.

So What Am I Saying?

“Natural” substances aren’t always safe or effective. They’re also not always unsafe or ineffective. The one thing we know for sure about them is that they are expensive, but the most alarming issue is the uncertainty. Conventional medications certainly have side effects as well–sometimes severe ones, but we typically know what to watch for and what doses would be appropriate. I think the best strategy is to simply avoid treating anything that doesn’t require treatment. But when I have to treat my child’s illness (or your child’s illness), I would rather use something that has been extensively tested, so that I at least know what I’m dealing with. That said, I’m not denying the possibility that some treatments currently considered “alternative” may one day find their way into mainstream medicine; they may in fact be safer and more effective than what we’re using now. But until we know for sure, just be careful. If you’re using or considering using supplements or alternative treatments for your child, discuss them with your doctor–it’s always better for him/her to know the whole story.

Here are a few other points to consider:

  • Many current medications (aspirin, penicillin, quinine, digoxin, taxol…) were initially “natural” therapies.
  • Many “natural” substances (hemlock, belladonna, arsenic, mercury, cocaine…) are harmful or potentially fatal.
  • “Natural” substances are chemicals, just like pharmaceuticals. They’re just produced in a different way. The fact that they were made in a lab doesn’t mean your body reacts to them any differently.
  • Even helpful substances can be harmful in excess. Vitamins cause toxicity in high doses; phytoestrogens from soy products have undesired endocrine effects; sunlight causes cancer.

Note: If you’re curious to learn more about cystic fibrosis, or if you have friends or family members with the disease, the Cystic Fibrosis Foundation website is a great place to start. 

As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

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