White Coat Underground

After reading the Canadian Association of Naturopathic Physician’s idiotic flu handout I decided to see what our American naturopaths had to say about flu. It’s not good. The most effective way to prevent influenza is through vaccination. Good hand hygiene probably helps. Nothing else really does, but that has never stopped quacks from making wildly bogus claims.

The American Association of Naturopathic Physicians has a page on “preparing for flu season naturally” which of course fails to mention the most effective prophylactic treatment, presumably because it’s “unnatural”. I’m not sure how they define natural, as taking supraphysiologic amounts of various vitamins is not exactly natural. But what about their claims? They don’t actually cite literature so we may have to do a little digging here.

They claim vitamin C can prevent influenza and mitigate its course. What they fail to say is that the overwhelming evidence is against any clinically significant benefit to vitamin C supplementation for respiratory infections (one study suggested that it can reduce the duration of colds by about 8%).

They recommend zinc vitamin A as being vital to immune function. This says nothing about their ability to help prevent flu. In fact, intranasal zinc can can cause irreversible damage to the sense of smell, and vitamin A can support the growth of some cancers.

Next up, Elderberry and Larch. Elderberry has some interesting in vitro studies to go with it but evidence of significant utility in people is lacking. The data on Larch for influenza is non-existent.

Echinacea has consistently failed to do a damned thing for prevention or treatment of respiratory tract infections.

There is only one proven way to prevent flu and that’s vaccination. One might argue that the webpage is about “natural” treatments, but given that there is no clear way to decide what is natural, that argument fails. Also, what’s the point of touting “natural” remedies if they don’t work? A less deceptive site would simply say, “so-called natural remedies have never been shown to do a damned thing to prevent or treat flu, so get vaccinated”. Strangely, I could not find a single page on their website with vaccine information of any kind.

That, Dear Reader, is pretty damned scary.

Comments

#1 DrWonderful
December 14, 2009

First! Anyway, I hear naturopaths prescribe milk thistle for all sorts of liver toxicity issues. Is there any evidence that this might be helpful? Or have you already pre-determined (assumed) it’s woo because naturopaths prescribe it?
#2 PalMD
December 14, 2009

If there is a plausible idea, it can be investigated, then the evidence will show what it will. My first question is “what is liver toxicity issues”?
#3 bridget
December 14, 2009

How about elevated liver enzymes (AST and ALT) without any apparent cause?
#4 DrWonderful
December 14, 2009

Hah, your guess is as good as mine. I’m just a chiro (and obnoxious).

I just saw a link tonight on MedPage about a new study showing that milk thistle helps detox livers in children following chemo. So I checked PubMed and there really seems to be some use for milk thistle as an liver anti-oxidant. I only noted it because I had aptient who saw a naturopath that prescribed it last year for liver issues. I honestly cannot remember what the liver issues were as I was treating for a cervical disc (and using manip no less).
#5 D. C. Sessions
December 14, 2009

They claim vitamin C can prevent influenza and mitigate its course.

Easy enough to check that one. If it’s true, you’d hardly ever see a case in places where the usual diet is rich in vitamin C. Foods such as fresh fruits are helpful, but the real champions of the vitamin C world are the capsicum tribe.

You’d never see it in places where people eat lots of fresh fruits and chili peppers. Like, say, Mexico.
#6 D. C. Sessions
December 14, 2009

I just saw a link tonight on MedPage about a new study showing that milk thistle helps detox livers in children following chemo. So I checked PubMed and there really seems to be some use for milk thistle as an liver anti-oxidant.

And we all know that antioxidants detoxify the liver. That’s what the lemon juice is for in the liver detox.
#7 Ian Musgrave
December 14, 2009

Milk thistle contains Silymarin, which is an antioxidant, it helps protect against carbon tetrachloride toxicity in rats, and in cases of mushroom poisoning (when given intravenously), but not against aflatoxin induced hepatotoxicity.

It doesn’t seem to do anything for viral hepatitis or alcoholic cirrhosis.

The Cancer study referenced by Dr. Wonderful is rather underwhelming, bilirubin and ALT were not affected by 56 days of milk thistle administration during chemotherapy and there was a (very) marginal reduction in AST at 56 days (but not 28 days). There were no significant clinical differences.

So if naturopaths are prescribing milk thistle for “all sorts” of liver “toxicity”, then mostly they are doing nothing helpful, and are possibly being harmful by reducing access to evidence based therapies.

References:
An updated systematic review with meta-analysis for the clinical evidence of silymarin.
Saller R, Brignoli R, Melzer J, Meier R.
Forsch Komplementmed. 2008 Feb;15(1):9-20.

Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases.
Rambaldi A, Jacobs BP, Gluud C.
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003620.

A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL)
Elena J. Ladas, MS, RD et al Cancer 10.1002/cncr.24723
#8 Dianne
December 14, 2009

Or have you already pre-determined (assumed) it’s woo because naturopaths prescribe it?

There are 339 citations for “milk thistle” in PubMed, so whatever PalMD’s personal opinion on milk thistle, the “allopathic establishment” seems to have found it work investigating. It’s mostly preclinical stuff, though, limiting to “clinical trials” cuts the cites down to 26. Some interesting stuff about use of milk thistle derivatives in chronic hep C infection, but nothing I’d call conclusive as of yet. I’ve also heard of it being used in amanita (sp?) poisoning, though I’m not sure the evidence is very good there-people tend to throw everything they’ve got into mushroom poisoning cases.
#9 Laura
December 15, 2009

One thing to consider is that Milk Thistle interacts with the same enzyme grapefruit juice does forgot the name so it can interact with some meds.
#10 Ian Musgrave
December 15, 2009

Laura wrote: “Milk Thistle interacts with the same enzyme grapefruit juice does”

The hepatic drug metabolising enzymes CYP3A4 and CYP2C9, Milk Thistle has the potential to interfere with some chemotherapy drugs, anti-HIV medications and the like.
#11 Jeff
December 15, 2009

There is evidence that Echinacea can be effective for colds (a type of RTI). This Lancet meta-analysis found a specific brand of Echinacea decreased the odds of developing the common cold by 58% and the duration of a cold by 1·4 days.

Here’s a 2007 paper describing how vitamin C could be useful dealing with flu pandemics:
Ascorbic Acid Role in Containment of the World Avian Flu Pandemic

Most public health officials insist on putting all their eggs in one basket (vaccination). Why not use every weapon at your disposal, including supplements? Good nutrition is fundamental to effective immunity (innate and aquired).
#12 Pareidolius
December 15, 2009

Larch and Elderberry? Paging Dr. Python . . . Dr. M. Python pick up the white courtesy telephone please.
#13 dmcw
December 15, 2009

From the Cochrane site about Echinacea and colds.

“Main results
Sixteen trials including a total of 22 comparisons of Echinacea preparations and a control group (19 placebo, 2 no treatment, 1 another herbal preparation) met the inclusion criteria. All trials except one were double-blinded. The majority had reasonable to good methodological quality. Three comparisons investigated prevention; 19 comparisons investigated treatment of colds. A variety of different Echinacea preparations were used.

None of the prevention trials showed an effect over placebo.

Comparing an Echinacea preparation with placebo as treatment, a significant effect was reported in nine comparisons, a trend in one, and no difference in six. Evidence from more than one trial was available only for preparations based on the aerial parts of Echinacea purpurea (E. purpurea).

Authors’ conclusions
Echinacea preparations tested in clinical trials differ greatly.

There is some evidence that preparations based on the aerial parts of E. purpurea might be effective for the early treatment of colds in adults but the results are not fully consistent.

Beneficial effects of other Echinacea preparations, and Echinacea used for preventative purposes might exist but have not been shown in independently replicated, rigorous RCTs.”
#14 mizz.lee
December 15, 2009

I’m curious about their suggestion to use a salt water gargle, since this is something I’ve done for colds and sore throats since I was a kid. I did a quick look around the interwebs, and didn’t find anything very convincing. Is there any evidence that a salt water gargle can prevent or limit infections of the throat?
#15 PalMD
December 15, 2009

No, but it feels good.
#16 catgirl
December 15, 2009

If someone has a vitamin C deficiency, then taking Vitamin C will help their immune system. But the effect isn’t linear, so people who get enough won’t benefit from taking even more. Why is this concept so difficult for some people to understand? Vitamin C is water-soluble anyway, so taking extra is like continuing to pour water into a glass that is already full and overflowing.
#17 Terrie
December 15, 2009

The point of a salt water gargle is not address the infection, but the sore throat. A high salt content will draw water out of the tissues, via osmosis. This will reduce inflammation and swelling.
#18 Chris
December 15, 2009

End then, Mister “Spammer” Montegue, you get to cause the remaining .0000001% of the germs to develop into superbugs.

Vaccines are a better solution than your magic cleaning crud.
#19 PalMD
December 15, 2009

I zapped him.
#20 Tian
December 22, 2009

I find it interesting that a MD would spend his time bashing everything that does not make them money? Hmm

I also find in very interesting how these same people attack homeopathy. They call it quack science, untrue and unproven. Then tell me if homeopathy is quackery, then why do you support vaccines? Very Very interesting indeed. The too have the same approach but only a vaccine seems to get the praise?

You might be a MD, but that does not make you an expert on everything. To think so would be foolish. In fact it would be dangerous.

What about the hx of medicine. How much do you really know about it?

I have seen ND’s and I can assure you that they are competent at what they do. One thing also comes to my mind, in that I have never seen a ND attack or bad mouth a MD. Instead it seems to be the other way around.

The bottom line is that in this country we operate a FOR PROFIT healthcare system. That in itself can bring out the worst in people. More concerned about shareholders profits than curing disease.

What would you have to say about the Vioxx scandal? I wonder how many more of these scandals go on without us every knowing?

I have seen very poor MD’s that still manage to keep their license.

Why do we not talk about these?