Naturopathy and naturopaths are a fairly frequent topic on this blog—and for very good reason. If there is an example of a pseudomedical “discipline” that has been gaining undeserved “respectability,” it’s naturopathy. It’s licensed in all too many states, and physicians who have fallen under the spell of so-called “integrative medicine,” a specialty that rebrands science-based lifestyle medical interventions as somehow “alternative” or “integrative” and uses them as a vessel to “integrate” quackery into medicine, seem to have a special affinity for naturopaths. Indeed, so common has the presence of naturopaths become in academic integrative medicine programs that I’m more surprised when I don’t see one in a program than when I do. Sadly, even my medical alma mater, the University of Michigan, has a prominent “academic naturopath” (an oxymoron if ever there was one) on faculty, and the Society of Integrative Oncology has had not just one, but two, naturopaths as its president in recent years. Basically, doctors, particularly integrative medicine physicians with an MD, have pretty much zero clue what a cornucopia of vitalistic, mystical, pseudoscientific nonsense the vast majority of naturopathy is. The rest (diet, exercise, lifestyle) is nothing unique to naturopathy or anything for which naturopathy is required. Basically, to paraphrase the great Harriet Hall, what is good about naturopathy is not unique, and what is unique about it is not good.

That’s why I periodically like to remind my fellow physicians what naturopathy really is. One way to do that is to point out the sorts of dangerous and unscientific practices embraced by many naturopaths. I saw just such an example earlier this week in, of all places, Ars Technica, in the form of an a story about a case report of a patient poisoned by a naturopath. How that naturopath accomplished the poisoning is something I hadn’t heard of before, making this a two-fer, a reminder of naturopathic quackery and something new that I don’t recall having seen before. I particularly like the title, Naturopath teaches real doctors something—a new way to cause liver damage. The case report tells the tale, Severe liver injury due to Epsom salt naturopathy. Of course, ccase reports are not in and of themselves necessarily indicative of a trend, but in this case, when taken in context with all the other things naturopaths do and the harm they can cause, this particular case report is a cautionary tale.

Epsom salt is basically magnesium sulfate, and Epsom salt solutions have long been used for a number of purposes. In this case a naturopath was using Epsom salt to dissolve gallstones:

A 38-year-old non-alcoholic, non-diabetic man with gallstone disease was prescribed three tablespoons of Epsom salt (magnesium sulfate crystals) with lukewarm water for 15 days for ‘stone dissolution’ by a naturopathy practitioner.

There is, of course, no evidence that magnesium sulfate can dissolve gallstones. Indeed, even compounds known to be able to dissolve stones, like ursodeoxycholic acid tablets, don’t work very well and are almost never used. Basically, channeling my old general surgery knowledge, I know that asymptomatic gallstones are usually left alone. When they become symptomatic, that is usually an indication for surgery to remove the gallbladder, particularly if the patient develops acute cholecystitis or other complications of gallstone disease. Basically, gallstone disease is a surgical disease, to be watched if asymptomatic and operated on if it becomes symptomatic or causes complications.

The man treated by this naturopath did not do well:

He developed loss of appetite and darkening of urine from the 12th day on treatment and jaundice from the second day after treatment completion. The patient denied fevers, skin rash, joint pains, myalgia, abdominal pain, abdominal distension and cholestatic symptoms. Examination revealed a deeply icteric patient oriented to time, place and person without organomegaly or stigmata of chronic liver disease.

Jaundice, of course, is an indication of liver dysfunction, which can be due to obstruction of the biliary system or damage to the liver tissue itself (hepatocellular injury). Darkening of the urine is a sequelae of the elevated bilirubin levels in the blood that result in jaundice. The patient’s blood chemistry values were consistent with hepatocellular injury as a cause of his jaundice. These lab values, however, are nonspecific and can only tell us that there is liver cell injury, not the cause. That required further tests:

Tests for viral hepatitis A, E, B, C, cytomegalovirus, Epstein-Barr and herpes simplex viruses and those for autoimmune hepatitis and IgG4 disease were unremarkable. There was no evidence of underlying sepsis and other organ failures. Contrast enhanced CT of upper abdomen revealed only hepatomegaly with mild periportal oedema. Percutaneous liver biopsy revealed submassive necrosis with dense portal-based fibrosis, mixed portal inflammation, extensive perivenular canalicular and hepatocellular cholestasis with macrovesicular steatosis and perisinusoidal fibrosis (suggestive of steatohepatitis) without evidence of granulomas, inclusion bodies or vascular changes suggestive of acute drug-induced liver injury (figure 1). Polarising microscopy did not reveal crystalline deposits.

Translation: There was no evidence for viral infection or autoimmune hepatitis, nor was there evidence of sepsis. The liver was enlarged. The biopsy revealed “submassive” death of liver tissue with inflammation and scarring. This resulted in cholestasis, the stasis of bilirubin in the biliary system. Steatohepatitis is hepatitis associated with fatty infiltration of the liver, often a sign of liver injury. (Alcohol, for instance, can cause the same fatty infiltration of the liver with inflammation, albeit usually much more chronically.) In other words, this man’s liver was messed up.

Fortunately, the liver is an incredibly resilient organ. Cessation of Epsom salt intake resulted in the man’s recovery, with his lab values returning to normal in 38 days. The authors note that Epsom salt overuse can cause diarrhea, electrolyte abnormalities, kidney injury, and cardiac arrhythmias. However, it can also cause liver injury:

Liu et al described the patterns of mineral-associated hepatic injury due to inhalational or intravenous exposure with pure silica, chromium-cobalt alloy and magnesium silicate (talc) in seven patients.3 They demonstrated that silica led to formation of sclerohyaline nodules within portal tracts and lobules in contrast to magnesium silicate injury that was associated with a predominant reactive fibrosis in portal and centrilobular areas. These patients were chronically exposed, in contrast to our patient who consumed Epsom salt in large quantities within a short period of time leading to predominantly necrotic and dense reactive fibrotic type of injury. Epsom salt-related severe liver injury and its histopathology have not been described in literature before. The Roussel Uclaf Causality Assessment Method (RUCAM) score was strongly suggestive of Epsom salt injury in our patient. We believe that underlying non-alcoholic steatohepatitis potentiated extensive liver injury in our patient, which resolved on stopping the offending agent.

Basically, the authors are explaining that what was observed in this patient was different from what is usually observed in patients with toxicity due to magnesium salts in that usually such toxicity is chronic, which results in fibrosis or scarring. In this case, the toxicity was acute and resulted in the death of significant swaths of liver tissue. Now, I will admit that I was not familiar with the Roussel Uclaf Causality Assessment Method (RUCAM) for liver injury. So I looked it up. It turns out that it’s a system for assessing the likelihood that a given drug is the cause of acute liver injury observed. Points are awarded for seven components:

  • Time to onset of the injury following start of the drug
  • Subsequent course of the injury after stopping the drug
  • Specific risk factors (age, alcohol use, pregnancy)
  • Use of other medications with a potential for liver injury
  • Exclusion of other causes of liver disease
  • Known potential for hepatotoxicity of the implicated drug
  • Response to rechallenge

Total scores range from less than 0 to 14 with scores below 3 indicating unlikely, 4-5 possible, 6-8 probable, and >8 highly probable hepatotoxicity. The scale isn’t that commonly used, because interpretation of some of its components can be a bit subjective, but it is useful for suggesting drug-caused liver toxicity, and clearly this patient had enough positives in his RUCAM assessment for his liver was highly suggestive that the injury was due to Epsom salt. Also, normally, when Epsom salt is used as a laxative, it’s recommended that patients take 10-30 g in at least 250 ml water. This man was taking 45 g every day.

Edzard Ernst noted that this isn’t the only serious adverse event that can occur as a result of excessive Epsom salt use. For instance, there is a case report of a fatality from hypermagnesemia (elevated blood magnesium levels) due to an Epsom salt enema administered to a 7 year old. Yes, a 7 year old.

Basically, naturopaths have advocated Epsom salt to “dissolve” gallstones for a very, very long time, even though there is no evidence that they are efficacious for this purpose. Whenever someone asks, “What’s the harm?” I can answer: Right here. Whenever considering alternative treatments like this, it’s important to remember that even benign substances (like Epsom salt) can be dangerous if used to excess. Unfortunately, all too often naturopaths think that, if a little is good (or at least harmless), then a lot will be better, and a hell of a lot better still. That’s a major part of the philosophy of naturopaths, if you leave out homeopathy, and that’s how you fry someone’s liver with something as seemingly benign as Epsom salt.

Comments

  1. #1 Panacea
    October 6, 2017

    So the follow up to this story is going to be the arrest of the naturopath for poisoning the patient, right?

    Silly me, what am I thinking.

  2. #2 darwinslapdog
    October 6, 2017

    What training do naturopaths receive in Britain? Not that it makes much difference, of course.

  3. #3 darwinslapdog
    October 6, 2017

    I just read Ernst’s entry on this and it seems the case was in India, no? What constitutes a naturopath in India? I don’t want to appear to defend naturpoathy in any way, but are US quacks likely to use Epsom salts in this way? Actually, who knows what any (“accredited” or otherwise) naturoquack might offer?

  4. #4 Concerned
    October 6, 2017

    The author of the Ars technica piece is Beth Mole. Her coverage of quackery like homeopathy has been consistently excellent: https://arstechnica.com/author/beth/

  5. #5 Panacea
    October 6, 2017

    @darwinslapdog: they used a spice to treat eczema. I don’t put anything past notadoctors in the United States.

  6. #6 Dangerous Bacon
    October 6, 2017

    So, is the answer homeopathic doses of epsom salts?

  7. #7 Freda
    United States
    October 6, 2017

    People are going this route because if you are on Medicare MD no longer want you as their patients they can’t get enough money out of the insurance companies when you have Medicare they don’t want you in their practices you’re no longer getting any Healthcare so these patients are left out there and lala land and so now we’re looking at Nora pass or alternative medicine and supplements or anything that we can grasp and hold onto to manage our pain and our illnesses and are suffering because we are being thrown away and I happen to be one of them I’m in so much pain right now I wish someone would take a gun out and shoot me dead on suffering so badly and no one wants to help me and it’s been going on for 3 years because I’m a Medicare patient no one gives two s**** after you get 65 you can forget about your life.

  8. #8 Meg
    United States
    October 6, 2017

    Freda, So, rather than go to a doctor who takes Medicare, you give your hard earned money to quacks? I don’t understand.

    My exceedingly cranky 70-year old brother has recently had cataract surgery, cardiology appointments and oncology follow up visits on Medicare. If he was having a problem getting healthcare, I’d know about it. He does complain about the lack of dental.

    Note: I’n not suggesting that 70-year olds are all cranky. He has been cranky his whole life.

  9. #9 JP
    October 6, 2017

    People are going this route because if you are on Medicare MD no longer want you as their patients they can’t get enough money out of the insurance companies

    I’ve seen several MDs over the past year and I’m on Medicaid, which pays even less than Medicare. (I have a very nice GP, I see a psychiatrist, and I’ve seen an ophthalmologist and a neurologist.) It’s definitely not impossible to get quality care on govt. insurance.

    I’m in so much pain right now I wish someone would take a gun out and shoot me dead on suffering so badly and no one wants to help

    Wow, that’s awful; I’m sorry to hear that. It still seems like science-based medicine is a better bet than quackery, though. I mean it’s more likely to actually help.

    Do you maybe live in a rural area where there isn’t a lot of choice of doctors or something? I live way out in the sticks, but luckily there is a good clinic in the town across the river (mainly it serves low-income folks and immigrants.)

  10. #10 JP
    October 6, 2017

    He does complain about the lack of dental.

    Yeah, Medicaid (in WA) does at least cover most dental procedures, unlike Medicare. Medicare should include dental.

    I mean it can be hard to find a dentist who takes Medicaid, but the same clinic I go to for my health care has a dental clinic that I go to. Which reminds me that I’m overdue for a cleaning.

    (I’ve been avoiding having my wisdom teeth pulled, ugh. All they really offer for the procedure is nitrous, so, ugh. They never quite fully came in, so they’re impossible to brush well, which means they have little cavities now.)

  11. #11 Alia
    October 6, 2017

    @JP I feel your pain. I had two of my wisdom teeth surgically removed, because my lower jaw was too small for them and they were impacted. And even though I am (theoretically) fully insured, I would have to wait so long for the procedure (and I’m not sure about anesthesia) that I decided to pay.

  12. #12 JustaTech
    October 6, 2017

    JP @10: when my wisdom teeth (upper) came in in my 20’s my dentist offered to pull them.
    My response was that as long as they aren’t messing anything up or full of cavities I’ll keep them. I have no interest in having them pulled if they’re not doing anything, even if they didn’t come in far enough to be actually useful for chewing.

    I’ve been told that the trick for most dental procedures is to ask for a second dose of novicane when they’re finishing up, so you have time for the oral pain meds to start working before the numbing goes away.

  13. #13 JP
    October 6, 2017

    @JustaTech:

    Thanks for the advice.

  14. #14 Tim
    October 6, 2017

    I’m in so much pain right now

    Might try CBD…

    cannabidiol (CBD, a non-euphoriant, anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis, and in 2007 for intractable cancer pain.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/

  15. #15 Johnny
    127.0.0.1
    October 6, 2017

    Heh.

    Just like antivaxers think vaccines cause every disease and syndrome, potheads think pot cures every disease and syndrome.

  16. #16 Tim
    October 6, 2017

    I get it, Johnny. As it is, It happens to be efficacious– You will never embrace that, no matter how much in pain your loved ones become — It is not what I, as a pothead, think but what is self evident with people in athletics, arthritis, cancer, seizures, eating disorders, and social interaction improvements from otherwise taciturn and withdrawn persons.

    Keep up the good fight, Johnny. It will take history a good while to record that you were on the wrong side of it.

  17. #17 Panacea
    October 6, 2017

    Yeah, well one man’s self evident is anyone else’s unsupported claims.

    I feel for you, Freda. There are, sadly, people who suffer from intractable pain and getting the right kind of help can be difficult.

    That’s not Medicare’s fault and it has nothing to do with vaccine science. It is not better to give your money to quacks for fake medicine.

  18. #18 Sid Aust
    United States
    October 6, 2017

    What biased bullshit article.
    300,000 die at hands of conventinal medicine and they get a free pass..what would happen if an airline killed that many in a yr…they would be shut down….

  19. #19 Johnny
    127.0.0.1
    October 6, 2017

    You will never embrace that, no matter how much in pain your loved ones become…

    How much pain someone is in doesn’t enter into it. I’ll embrace it when the evidence comes in.

    It’s plausible that pot can be made into good medicine. Plants have powerful juju, and here’s a long history of this. But don’t try to convince me that it’s the wonder drug that works wonders with the current body of evidence, because it just isn’t there.

    In the mean time, if you want cheap, legal, readily available pot so you can get high, just say so. It ain’t a sin (except among the Mormons, and a few others).

  20. #20 Epsilon
    Spotting deniers outside of their natural habitat
    October 6, 2017

    “What biased BS article”

    Ooh, look! The first bile-spewer has appeared.
    And gosh, that atrocious grammar would have my old english teacher in conniptions.

  21. #21 Se Habla Espol
    October 6, 2017

    @Freda, #7: I’m 75 and on Medicare. I’ve no trouble whatsoever finding doctors and hospitals who accept me and give me good care. Perhaps it’s the difference between my attitude and yous that could make a difference in how we are treated.

  22. #22 Narad
    October 6, 2017

    As it is, It happens to be efficacious– You will never embrace that, no matter how much in pain your loved ones become — It is not what I, as a pothead, think

    There are at least two word-meaning problems in here, “Mitzi.” BTW, I continue to forget the outcome of that episode in which your father for some reason hired a hit man to take you out with helicopters, or whatever the f*ck that was. Please do refresh the recounting.

  23. #23 sirhcton
    October 6, 2017

    . . . with lukewarm water

    There’s your problem, right there. That stuff is filled with hydrogen hydroxide.

  24. #24 Old Rockin' Dave
    October 7, 2017

    Be careful with lidocaine or its analogues.I am aware of one case in which lidocaine was repeatedly injected into the site of surgery in a cumulative dose sufficient when absorbed to cause a serious bradycardia.
    I admit that one occurrence does not add up to real data. It’s also a very unlikely complication, but it can and did happen..

    • #25 Orac
      October 7, 2017

      This is something that every surgeon knows about. We know how much lidocaine can be used before toxicity can result in arrhythmia. It’s pretty basic information.

    • #26 Se Habla Espol
      October 7, 2017

      ORD, The Wife had a serious bradycardia attack from a lidocaine patch that was supposed to relieve pain.

  25. #27 nimo
    October 7, 2017

    Useless article. Would you like to report on the thousands of cases where the innocent die every year due to medications, medical errors and misdiagnosis?

    • #28 Se Habla Espol
      October 7, 2017

      That’s been done, including reporting on the many programs throughout the medical field to address and correct the situations. These programs have been pretty successful over the years since your information was first published.

      For example, Monday, i will go to my ophthalmologist. His nurse will place a mark on my forehead over my right eye; another nurse will check it against the orders. When the doctor gives me my injection, he will use that mark to double-check that he’s putting the injection into the correct eye.

      Would you care to report on safety programs in sCAMmers’ offices?

  26. #29 Alain
    October 7, 2017

    BTW, I continue to forget the outcome of that episode in which your father for some reason hired a hit man to take you out with helicopters, or whatever the f*ck that was.

    I can attest that his father hired me to take Mitzi out. Helicopter (black of course) and other details where left out of the conversation at my discretion.

    Taciturn and withdrawn Al 😉

  27. #30 Epsilon
    Look another one's come to distract from the real issue
    October 7, 2017

    “Useless article”

    More like useless comment. You have to take into account how many of those errors and misdiagnoses are from patient error, not doctor error.

  28. #31 Walt Garage
    USA
    October 7, 2017

    What is the actual purpose of Epson salts?

  29. #32 Walt Garage
    USA
    October 7, 2017

    Do epson salts have any real medical purpose

  30. #33 Dianne
    United States
    October 7, 2017

    I almost died at the hands of MD’s…Not to say they are all inept….but one size does not fit all. It wasn’t until I went to a holistic Dr. NATURAPATHIC…ALL PRACTICES NOT OF WESTERN MEDICINE. DI’d I begin to heal. You talked about proof of evidence that a natural protocol worked…..well it hasn’t proven that chemo works. Chemo kills the immune system… therefore killing the people that are on Chemo…..but it’s big business isn’t it. Naturapathics use western medicine and refer patients to MD’S When necessary…and that is usually because the AMA has control of most every kind of test etc. I guess you ate just trying to protect your interest….or you truly have no idea of what you are talking about.

  31. #34 JP
    October 7, 2017

    I use them to soak in a hot bath when I’m sore or particularly wound up; I don’t know if they actually do anything.

    They’re also a strong laxative when taken internally (according to the package.)

  32. #35 Meg
    October 7, 2017

    As I understand it, it really doesn’t do much in a bath. But, a nice warm bath is very relaxing. I like bubbles in mine.

  33. #36 JP
    October 7, 2017

    I used to buy big jugs of peach bubble bath from CVS; maybe I’ll get some soon.

    I also bought fancy scented and/or foaming bath salts for a while.

  34. #37 herr doktor bimler
    October 7, 2017

    Do epson salts have any real medical purpose

    They used to be a cure for constipation. Part of the traditional English obsession with emptying the bowels as a cure for all ailments… this may be an outcome of the traditional English diet, but it would be wrong to speculate.

    There was a big patent battle over the stuff, a few centuries ago:
    https://www.ncbi.nlm.nih.gov/pubmed/6085985

    [Grew’s] attempt to patent the production and sale of the Epsom Salts precipitated a dispute with two unscrupulous apothecaries, the Moult brothers. This controversy must be set against the backcloth of the long-standing struggle over the monopoly of dispensing of medicines between the Royal College of Physicians and the Worshipful Society of Apothecaries of London.

    Big Pharma at work, even then!

  35. #38 rs
    October 7, 2017

    Well, Dianne, I have a theory that going to a naturopath turns does irreparable damage to the language and reasoning functions of the adult brain. This is of course only a tentative conclusion based solely on a case series of drive by commenters. I look forward to increasing the sample size.

  36. #39 ScienceMonkey
    October 7, 2017

    Dianne – I am a naturopath in the state of Indiana and I have multiple Board certifications in naturopathy. I have zero formal training. Zero. I can set up shop, throw on a lab coat, and treat customers. Yet, I don’t practice because I have ethics.

    Think on that for a while.

  37. #40 Chris
    October 7, 2017

    nimo and Dianne, please the verifiable statistics showing the efficacy for gall stones between epsom salts and the simple out patient surgical removal of the gall bladder. Just post the PubMed indexed articles by reputable qualified researchers.

    If you are going to criticize this article, you should provide the evidence that the naturopath’s treatment that almost killed the patient has any, and perhaps better, outcomes.

  38. #41 Epsilon
    Naturopaths don't fit anyone dude
    October 7, 2017

    If chemo is so horrible explain how so many more people survive breast cancer than ever before, and how it hasn’t come to light yet.
    Cuz I don’t appreciate you bashing all of the wonderful doctors that just want to help people.

  39. #42 Narad
    October 7, 2017

    Do epson salts have any real medical purpose

    They used to be a cure for constipation.

    Wait, MDC doesn’t count?

  40. #43 Narad
    October 7, 2017

    ^ Heh.

  41. #44 Old Rockin' Dave
    October 8, 2017

    I propose a test.
    Let’s dilute a naturopath to 100C and see how much more effective they become.

  42. #45 Epsilon
    Tired as heck
    October 8, 2017

    @Dave,

    What do you mean, “more effective”? They never were in the first place.

  43. #46 Narad
    October 8, 2017

    Now that I look more closely at it, MDC has really become a horror show of visitor monetization. Some might recall that, back in the day, before the brand was purchased and resucsitated, it was a back-to-the-land routine where babby’s survival didn’t really matter all that much because they’s more babbies where that one came from, anyway.

    This item about epsom salt, the capitalization of which is wholly obscure to me, is a prima facie classic, though:

    The other day, morning sickness hit me hard! I woke up feeling like junk and needed food, stat! (But of course, not the “normal” food I’ve been eating).

    I have been hearing for a while how magnesium helps with MS. I’ve been intrigued. I thought I was doing great with diet, etc, because I had been feeling pretty good. But then the other day, BAM. And the smells, of course as I’ve shared in other posts.

    Anyway, I had DH pick up some Epsom Salt so I could take a bath in it (magnesium is best absorbed through the skin, but I’ve heard taking Natural Calm or other supplements can help too). I took a bath Saturday night, felt great Sunday morning (though I almost heaved a little later because of phlegm. Ugh). Last night, I just soaked my feet for 20 minutes, and felt pretty well this morning too.

    Has anyone else used magnesium to fend off MS? Epsom salt or magnesium oil or a supplement? I’m curious to see how this works for others!

  44. #47 Narad
    October 8, 2017

    ^ “resuscitated”

  45. #48 Old Rockin' Dave
    October 9, 2017

    Epsilon, any effectiveness at all would be more than the uniform level of none at all.
    Anyway, diluting naturopaths in large volumes of water is likely a good thing in itself, even without any other purpose.

  46. #49 Epsilon
    Stated for the record: IVs suck
    October 10, 2017

    @Dave

    Maybe we should just throw ’em all in a pool then. At least it would be entertaining.

  47. #50 prn
    October 10, 2017

    I dunno. This article seems a little opportunistic without some ties to US naturopathy since most Epsom salt is for foot/bath salt. OTC mag citrate is going have a lot lower yuck factor for patient compliance/perceptions.

    Has anyone tried to validate this article’s Indian case against US naturo schools or their training?

    A lot of weird medical sh**, er practices, go on in Asia because of the extreme poverty in the previous centuries.

  48. #51 Panacea
    October 10, 2017

    prn: you mean like acupuncture, reiki, and a whole s***load of herbal remedies? Like using turmeric IV to treat eczema?

    Quackery is quackery. That this particular clusterf*** happened in India doesn’t make American quackery any less stupid.

  49. #52 madder
    October 10, 2017

    prn, I’d be a lot more receptive to your dismissal of this event if you could show me that it was firmly outside the standard of practice in US naturopathy.
    Oh right, you can’t: they don’t have a standard of practice.

  50. #53 prn
    October 10, 2017

    Panacea, that’s some rigorous inquiry that you use there. /sarc
    —-
    Dear Madder,
    Injury, cost and/or ineffectiveness are often part of why patients forego MSM’s claimed “standard practices”.

    For me personally, nonstandard means recovering better, cheaper, nicer answers, often missed in “standard medicine” for the last 2-8 decades. I can only handle MSM ala carte, still with undue risk and costs from MSM.

    A lot of the problems we see in these embryonic alternative medicine (mal)practices are due to the politicized processes of MSM itself. MSM’s real medical competitors have been repeatedly balked, scattered, destroyed, suppressed, (seemingly) discredited, preventing cumulative improvements of those parts with merit. Sometimes it leaves bitter residues of doubt and mistrust. So societally we seem to perpetually repeat failures instead fully advance past them with full, self actuated knowledge and confident integrity instead of the paper mache answers (with doubts and misinformation) often created by MSM.

    Beyond any object lessons learned, real quacks have to appreciated for their propaganda value to MSM interests for use against the more meritorious competitors, best stifled when aborning.

    It sometimes takes a lot of effort and delay to avoid the costs, risks and dangers of “standard medicine” and aggressive proclaimants. Worse is when MSM seeks to impose itself upon us, agreed or not. Ditto it’s overflowing costs.

  51. #54 Epsilon
    ???
    October 10, 2017

    I am genuinely confused, is prn suggesting naturopathy isn’t as bad as it seems?

    Cuz that’s utter baloney. Like there’s not enough sandwich meat in the world to get to that level of baloney density.

  52. #55 Panacea
    October 10, 2017

    Epsilon: that’s pretty much what he’s claiming. His particular fetish is high dose IV vitamin C.

    prn: how much rigor do I need to know that taking too much magnesium sulfate internally is life threatening? I happen to understand what happens when someone has hypermagnesemia because 1) I’m a trained health care professional, and 2) I’ve seen it in action working with patients with severe pre-eclampsia/HELLP syndrome.

    The dose makes the poison. There is no more clear an example of this principle than this case. A little is helpful for constipation. A little is helpful to reduce hypertension and reduce neural excitability (increase the seizure threshold). A lot will depress your CNS to the point your reflexes disappear, your kidneys stop working, and you stop breathing.

    This is not an issue of real medicine having flaws. This is basic pharmacology and physiology in action. Real medicine doesn’t HAVE competition that can do anyone any good. There are a lot of good scam artists out there, but if some modality were to actually work it would be called medicine and become part of the mainstream.

    I don’t have to appreciate real quacks (thanks for conceding they are quacks) for anything. They divert precious resources from research and real patients who are desperate for a cure, causing a lot of harm in the process . . . and you are part of that problem.

    Yes, costs are a problem in our health care system. Quackery doesn’t make that better and it’s not an alternative.

  53. #56 Epsilon
    October 10, 2017

    He does know that vitamin c is water-soluble, and therefore any excess of the daily need is passed in the urine?

    There’s like no use in taking extra? :/

  54. #57 Politicalguineapig
    October 11, 2017

    Epsilon: prn doesn’t appear to have ever noticed that, no. He also believes that everyone in the US is suffering from vitamin deficiency, mostly of c and d despite the fact that wide-spread deficiencies are largely a thing of the past.

    (And that there were a lot of very serious campaigns against rickets, for example which somehow totally escaped his notice).

    I don’t know why he’s got a fetish for those two vitamins in particular, but that’s his problem, not mine.

    He’s almost as bad as the woman who believes carrots didn’t exist before 1950, among other things, or the other lady who believes all Americans subsist exclusively on cheeseburgers.

  55. #58 Epsilon
    October 11, 2017

    Wow. That’s like mega retarded levels of delusion.
    And even if that was the case, it could be solved be taking some gummi-vites.

  56. #59 prn
    October 11, 2017

    Epsilon: I view MSM, naturopathy and CAM opinions and options as “separating the wheat and chaff” problems. Accordingly, I buy ala carte and save tons of money, with better results.

    We do some things at home better than (y)our doctors do at their leading hospitals; our various doctors from several hospitals acknowledge this in different ways.

    water-soluble…excess…extraa
    You know in science and math, epsilon often represents a small, erroneous quantity. Your bias and conclusory errors on vitamin C are much greater.

  57. #60 Mongrel
    October 11, 2017

    “This item about epsom salt, the capitalization of which is wholly obscure to me, is a prima facie classic, though:”

    Is it because it’s named after the town? https://en.wikipedia.org/wiki/Epsom

  58. #61 MI Dawn
    October 11, 2017

    Oh, prn. How little you’ve been missed.

    Vitamin C is a water-soluble vitamin. If you take more than your body needs, you just pee it out.

    If you take excessive doses over long periods of time, your body adjusts (over time) to a new normal. Then you can develop scurvy if you drop below your body’s new normal, even if you are taking what reasonable persons consider a “normal” dose.

    Vitamin C “may” decrease the duration of a cold by a day or so. Yippee. It has never been clinically proven to cure anything besides scurvy. You are always welcome to present peer-reviewed studies, preferably double-blinded ones, that show the contrary.

    I’ll be listening to the usual crickets in the meanwhile.

  59. #62 Politicalguineapig
    October 11, 2017

    PRN: I view MSM, naturopathy and CAM opinions and options as “separating the wheat and chaff” problems. Accordingly, I buy ala carte and save tons of money, with better results.

    Dude, you pay untrained people to poke holes in you. That’s not ‘separating the wheat from the chaff,’ it’s buying the chaff whole-sale.

  60. #63 Panacea
    October 11, 2017

    PGP: LOL

    She’s right prn. Spending hard earned money on unproven therapies isn’t separating the wheat from the chaff. It’s pouring good money down a rathole. Either you are the placebo effect in action, or you’re not really sick. Hypochondriac, maybe.

    In any case, you still suffer harm by giving charlatans your money.

  61. #64 Narad
    October 11, 2017

    Is it because it’s named after the town?

    Silly me.

  62. #65 madder
    October 11, 2017

    @prn:

    So choose to change the subject. I do not take your bait.

    Rather, I’ll take your evasion as an admission that high-dose magnesium sulfate for gallstones is not outside the naturopathic standard of care.

    Good to know.

  63. #66 Julian Frost
    Gauteng East Rand
    October 11, 2017

    If you take excessive doses over long periods of time, your body adjusts (over time) to a new normal. Then you can develop scurvy if you drop below your body’s new normal, even if you are taking what reasonable persons consider a “normal” dose.

    You learn something new every day.

  64. #67 MI Dawn
    October 11, 2017

    @Julian Frost: I was actually shocked to learn that – I expected you would just keep eliminating the excess. But apparently, your body will adjust over a long period. And I learned it by seeing a person with scurvy with the mega-dosing being the cause (they had had a financial problem, which meant they couldn’t afford the supplements, but were able to maintain a relatively healthy diet – with what *should* have been adequate C. I don’t recall after this many years exactly how much the person had been taking, but it was about 4-6 gms/day)

  65. #68 Politicalguineapig
    October 11, 2017

    MIDawn: “If you take excessive doses over long periods of time, your body adjusts (over time) to a new normal. ”

    Quick question, can this happen with any supplement? I’m on a megadose of iron currently for medical reasons, and I have some concerns about tapering off.

  66. #69 Panacea
    October 11, 2017

    PGP: how long have you been on a megadose would be my first question. IF, and I say if because I don’t know, being on high dose iron for a long period causes you to develop what is essentially tolerance, then how long would be important information.

    We don’t have to wean people who are on steroids for a short period. Long term, we do. Its a good conversation to have with your physician if you’re not sure. Are you seeing a hematologist? I would think one could tell you.

  67. #70 squirrelelite
    October 11, 2017

    @madder (65),

    That is the fundamental problem with naturopathy: there is no standard of care. So it’s basically do whatever you feel like and if that doesn’t work, ask one of your naturopathic friends to suggest a potion that might have worked for one of their patients.

    There is also the problem that, to be different, they focus on the chaff that has been discarded by science-based medicine as less effective or completely ineffective, if not outright dangerous, with a liberal helping of untested and potentially dangerous treatments like traditional Chinese and Ayurvedic herbal medicines.

    And they pretty much ignore science as a method for figuring out what works and what does not, as evidenced by their continuing embrace of homeopathy and reiki.

    And they aren’t trained on how to recognize their limitations and when to refer a patient to a real doctor, as evidenced by this case and the curcumin death.

  68. #71 Politicalguineapig
    October 11, 2017

    Six months. No, I haven’t seen a hematologist, though I just had my blood tested again. I did just see my physician, but she’s waiting on the blood test to see if my iron levels have gone up enough to think about tapering down.

  69. #72 madder
    October 11, 2017

    @squirrelelite:

    Yep. That’s exactly the point I was making in my roundabout way: prn can’t say that this is outside naturopathic SOC, because there isn’t one. That fact, along with the others you list, should terrify all prospective patients marks.

  70. #73 Panacea
    October 11, 2017

    Hopefully they’re better.

    I had iron deficiency anemia when I was a kid. Don’t remember much about it (I was nine), but I do remember drinking this really nasty liquid iron supplement mixed with orange juice. It was disgusting. Never was there a happier kid than this one at the end of a summer when I could finally stop drinking it.

  71. #74 Epsilon
    Memory is the key, if u get my gist. ;)
    October 11, 2017

    @prn

    Wow dude you’re calling the person with multiple chronic health issues “erroneous”? How immasculated do you need to be to stoop to that?

    Also, my name is a super-secret reference that only mega-internet-nerds will get. Looks like you failed. 😉

  72. #75 Politicalguineapig
    October 11, 2017

    Thanks, Panacea. I had my blood tested three months in, and my iron levels were definitely rising a bit, so I think I’m improving. And I have my flu shot, so I’m set for this year.

    Epsilon: I’m guessing you’re involved in physics?

  73. #76 prn
    October 11, 2017

    High dose iron and calcium are often problematic treatments that mostly appear in the diatetic – MSM recs/wrecks rather than CAM.

    At our house no one has needed iron pills for anemias from highest stage cancer, chemo, female or old age. Liver 1-3 TSB daily, perhaps “some” C etc, bumps up Hgb 2-5 g/dl in a week or two (we haven’t had any severe anemias to try out…). Liver product quickly and totally replaced those problematic iron pills early in the chemo game.
    —–
    I’ve seen an in-law weaned off MSM’s long term steroids with (IV) vitamin C and supplements and much improved quality of life.
    ——-
    madder@65
    Ah, your “scientific deductions” are amazing (ly wrong – I admit nothing of the sort. I’m just not searching everything stupid for you). I’d never heard of standalone high dose mag sulfate for dissolving gallbladder stones – rather more lecithin and the bile based tx.

    Magnesium related, mostly you hear of this liver/gallbladder “flush” – based on an oil, mag citrate, and lemon/grapefruit juice that produces bile colored soapstones that likely formed highly viscous liquid plugs sweeping microcrystalline sludge out, not true (small) stones.

  74. #77 Epsilon
    Memory is the key ;)
    October 11, 2017

    @PGP

    Goodness no, I’m nowhere near that level of science right now, but I do hope one day to reach such a level of nerdery one day. As of now I shall stick to my game nerdiness.

    It’s nowhere near that cool, being a reference from an internet show that I watch.

  75. #78 prn
    October 11, 2017

    MI Dawn
    …rebound scurvy
    Rebound scurvy is considered to be addressed by tapering over several days. However underlying illnesses may make people think that rebound scurvy goes longer rather than the higher maintenance level required.
    —-
    Vitamin C is not necessarily expensive. We buy C for $7-$10/kilo (under 1 cent per 1000 milligram). You can pay almost any amount higher that you like…
    —–
    Vitamin C is a water-soluble vitamin. If you take more than your body needs, you just pee it out.
    MSM badly confuses the issue of vitamin C conservation against scurvy with other benefit levels.One question should be “Why does MSM only dose once a day when it knows the kinetics ???”

    Vitamin C “may” decrease the duration of a cold by a day or so.
    This was based on studies of 250 – 2000 m Cg, without any vitamin D related data. Real vitamin C dosing uses bowel tolerance or IV. Ho hum, the doctor is dumb….

    Yippee. It has never been clinically proven to cure anything besides scurvy
    That’s an MSM failure to investigate. If you want the fastest cure, test IV vitamin C and high dose D3.

    • #79 Se Habla Espol
      October 11, 2017

      That’s an MSM the megavitamin peddlers’ failure to investigate. If you want the fastest cure, test IV vitamin C and high dose D3.We’ll wait until the megavitamin woomeisters are willing to actually test and validate the crap they peddle. I won’t hold my breath, though, since the snake-oil brigade is only good for excuses, never actual data.

  76. #80 prn
    October 11, 2017

    Either you are the placebo effect in action, or you’re not really sick. Hypochondriac, maybe
    Perhaps at your institution they ignore scanned mets and bone loss as hypochondria and unusual survival as placebo effect. Along with decades of debilitating bone and joint pain, undiagnosed with ultralow vitamin D. With you, I’m sure many [not here] could believe that.

    From my point of view, one could get less than 1/3rd (OS under 1%, “wipeout”) or 1/4 the 50% survival time with MSM for another $50-$100,000 per month, along with terrible side effects instead of enhanced performance. “No thanks”

    PS, Panecea: You frequently misinterpret me so conveniently with make-your-own-strawman, disingenuous replies. My sarcasm about your “rigorous inquiry” referred to your broad instant dismissal, like …a whole s***load of herbal remedies?, not the hypermagnesia incident. Magnesium is not even mentioned in your post at #51 immediately following mine, at #50.

  77. #81 Epsilon
    October 11, 2017

    @prn

    Holy smokes is that all you’re able to talk about? Is there some sort of brain chip implanted by your evil naturopathic overlords that won’t let you post anything if it doesn’t include the words “vitamin C”, “vitamin D”, and MSM?

  78. #82 Panacea
    October 11, 2017

    Epsilon: yeah, pretty much that’s his mode.

    prn: I find your claims to be disingenuous at best as they are impossible to confirm. In any case, if you had bone cancer, high dose vit D would not have cured it, which is why I call BS on your claim.

    Are you really this stupid? Orac’s article is about Epsom’s salts, which IS magnesium sulfate you twit.

    You then said in #50, “This article seems a little opportunistic without some ties to US naturopathy” wherein I replied in #51, “Quackery is quackery. That this particular clusterf*** happened in India doesn’t make American quackery any less stupid.”

    Essentially you tried to claim that since this over dose of mag sulfate happened in India it didn’t matter, because it has nothing to do with American naturopaths. Wherein I pointed out an American naturopath, a graduate of their holy grail school of Bastyr, did something equally as stupid when he killed a woman trying to treat eczema with IV turmeric. The idea that American naturopaths would never kill a patient recommending stupid, unproven, and dangerous treatments was laughable on its face.

    I then pointed out that the dangers of mag sulfate are well known, and that I know them through my experience as a registered nurse caring for antenatal and post partum patients with pre-eclampsia and HELLP syndrome using this very drug in my post at #55.

    If you don’t understand that very clear timeline, you are truly clueless, desperate, or both.

  79. #83 LW
    October 11, 2017

    At our house no one has needed iron pills for anemias from highest stage cancer, chemo, female or old age. Liver 1-3 TSB daily,

    Ick! Give me iron pills every day over liver! The only way I ever managed to choke down liver was to cut it into tiny cubes that I could toss in my mouth and swallow whole. Chewing liver … blech.

  80. #84 Panacea
    October 11, 2017

    LW: I’m with you there. Liver is just nasty.

    Fortunately, there are plenty of other ways to get iron without supplementation. Only pregnant women or people with a bona fide iron deficiency anemia should take iron pills. They constipate the bejeezus outta ya.

  81. #85 Politicalguineapig
    October 11, 2017

    LW, Panacea: Thirded. As for the constipation, I actually haven’t had much of a problem, oddly enough. Must be the fruit and the trail mix. Or the granola bars. (It’s telling that I think snake is superior to liver.)

    PRN: Dude, why are iron pills “problematic”? Is it that they’re not your preferred vitamins, or that I went to a doctor? (I had to buy the iron with my own money, ya know.)

    They’re supplements for pete’s sake! Just like you’re telling all the rest of us to take! Even for you, this is a new low in stupid.

  82. #86 Epsilon
    His bar's set deeper than the gravity well of a black hole dude
    October 11, 2017

    I wouldn’t say it’s a new low, just an old one coughed back up with a helping of self-contradiction like the world’s ugliest hairball.

  83. #87 Renate
    October 12, 2017

    I have to say, I like some liver, like codliver.

  84. #88 Panacea
    October 12, 2017

    PGP: I had a precancerous tumor that caused massive bleeding; my H&H dropped to 6 and 18, half what it should be. I got a blood transfusion and was on iron sulfate for about a month. Colace was my friend during that time. But hey, fiber and lots of water are probably a lot better for you. I didn’t have much of an appetite for awhile, so I needed the Colace.

  85. #89 madder
    October 12, 2017

    @Panacea:

    Yep, prn wants us to dismiss this event as not relevant to naturopathy in the US, but cannot reassure us that they won’t start doing it to their victims here. When given a second chance to do so, prn changes the topic several times and complains that real doctors won’t tell people to waste their money on particular unnecessary supplements. Somehow prn is sure that these supplements are in fact vital to treatment of just about any condition, but has no evidence in support of this claim, and it’s the real scientists’ fault that this evidence doesn’t exist.

    Gotta hand it to prn: it would take me a long time to come up with a line of argumentation halfway as flaccid and self-defeating as this one, but prn does it effortlessly. Bravo!

  86. #90 Politicalguineapig
    October 12, 2017

    Panacea: Ook, that sounds awful.

  87. #91 Panacea
    October 12, 2017

    PGP: It was. I almost died.

    The silver lining is, I know what it feels like to go into hemorrhagic shock, and I have a pretty good recollection of how it went down. The good news was, once they got the transfusion and some IV fluids into me, I stabilized very quickly. I spent a couple of days in the hospital, and about a week in bed once I went home.

    I learned a lot from that experience, and I channeled it into my work.

  88. #92 Politicalguineapig
    October 12, 2017

    Panacea: Well, I’m glad you got something good out of it, I guess. (Sorry, I’m just trying to wrap my head around it, and my emotional processors are down at the moment.)

  89. #93 Alain
    October 12, 2017

    Speaking about liver, I used to be in your rank and found the thing absolutely disgusting until I tasked this Bistro’s veal liver:

    http://www.beaverhall.ca/

    The art is in the cooking method but I must say that this is the best liver I tasted in my life.

    Al

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