White Coat Underground

If there were a parallel universe, and in that universe medicine, instead of being based on science, was simply a gemisch of various folkways and superstitions, medicine in that universe would be called “naturopathy”.

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“Remember.
Hey, how come this never works with water?”

I’ve discussed the absurdity of naturopathy nux vomica ad nauseum, but a loyal reader mentioned hearing that naturopathy might be good for allergies. This will require a bit of science to start off (unless, of course, Spock’s rocking the goatee).

Seasonal allergies are caused by a pathophysiologic process called “type I hypersensitivity”. For those of us with a genetic susceptibility to seasonal allergies a normally harmless environmental substance, such as pollen, make us miserable. The first time I was exposed to pollen, it lodged in my nose and was consumed by immune cells patrolling for invaders. It was chopped up, processed, and it’s proteins presented to other immune cells. Eventually, B-cells were exposed both to these cells and to pollen, matured into plasma cells, and started cranking out IgE antibodies. These antibodies are specific to the pollen I was exposed to. They can bind to it. But the other end of the antibody binds to cells in my nose called basophils and mast cells. These cells, with all of the pollen-specific IgE sticking out of them, hang out in my nose. When the pollen comes back, it locks on to these antibodies, causing the cells to flood my nose with histamine and other nasty substances. This makes my nose run, makes me sneeze, and makes me cranky.

That’s a very basic look at the science. We have a number of ways of blunting this reaction. We can use antihistamines to fight the effects of histamine. We can use mast cell stabilizers to prevent histamine release. We can avoid allergens. We can use inhaled steroids to block the late inflammatory responses. We can use desensitization therapy (allergy shots). All of these are based on an understanding of the way our immune system causes the condition we call “allergies”.

The website for the American Association of Naturopathic Physicians has a different approach to allergies, a more creative one. They recommend dietary changes to alleviate allergy symptoms, none of which are supported by any evidence in the literature, and most of which show just enough knowledge of immunology to get things spectacularly wrong. For example:

Red meat contains a substance called arachadonic (sic) acid, which helps to produce the cytokines and leukotrines that cause your immune system to react with allergic inflammation. While you need a small amount of arachadonic acid for your immune system to function, your body can produce this amount naturally. Simply eliminating red meat from your diet can reduce the level of this acid, thus lessening your allergic reactions.

Arachidonic acid metabolism is very important both for normal physiology and pathophysiology. AA is a substance our bodies made and use in a variety of ways. Some pathways of its metabolism involve the production of substances involved in inflammation, and certain drugs such as aspirin interfere with this. Some drugs, such as leukotriene inhibitors, interfere with another part of the pathway and are used to treat allergies and asthma. While dietary linoleic acid is necessary for the production of arachidonic acid, there is no evidence that changing this intake, or that any dietary interventions significantly aid in the treatment of allergies. There are a few non-clinical studies of certain dietary supplements, but none of these show convincing evidence for treating real people who have allergies.

The naturopaths have some further other-worldly recommendations:

Your options don’t end in the grocery store and vitamin shop! Naturopathy and other natural modalities offer a broad range of solutions to seasonal or year-round allergies.

Homeopathic remedies involve taking an extremely diluted form of selected allergens in liquid or sugar-pill form sublingually (under the tongue). These miniscule doses serve somewhat like a vaccination, stimulating your immune system to an effective rather than extreme response.

No. In this universe, with its particular laws, homeopathy is just water. It contains nothing but water, and that water remembers nothing of what might have been in the bottle it once came from. The “miniscule” doses are too miniscule to have any effect on the immune system, other than moistening it.

Naturopaths have no business treating allergies with anything they list on their website, at least not in this universe. And yet, they still try.

Fascinating.

Comments

  1. #1 Mary
    May 19, 2010

    Best headline I saw this week:

    Homeopathy is witchcraft, say doctors

    Although I think if they changed their name to the American Association of Witch Doctors it would actually make a cool T-shirt.

  2. #2 Joyce
    May 19, 2010

    “We can use desensitization therapy (allergy shots). All of these are based on an understanding of the way our immune system causes the condition we call “allergies”.”

    Since each time you are exposed to an allergen your immune systems fights it, how exactly is this effective in reducing symptoms?

  3. #3 PalMD
    May 19, 2010

    Desensitization aims to induce “immunologic tolerance” via the administration of successively larger doses of antigen. The exact mechanism is complex. It’s used not only for seasonal allergies but for drug desensitization when necessary, for ex when penicillin or aspirin are needed in a patient who has severe allergies to them.

  4. #4 WMDKitty
    May 19, 2010

    Nux Vomica works for nausea… just like sucking on a piece of hard candy works for nausea. But the candy tastes better.

  5. #5 daijiyobu
    May 20, 2010

    Excellent post. Always good to hear someone besides me criticizing naturo.

    Per “naturopaths have no business treating allergies,” that’s okay, they’ve decided that oncology is where they really “shine”

    http://www.snwcenter.com/natoncology.html

    “Psychospritual.” Love it.

    -r.c.

  6. #6 Dunc
    May 20, 2010

    Since homoeopaths and naturopaths are so fond of testimonials, here’s one: I tried homoeopathy for my allergies when I was younger, and surprisingly it made absolutely no difference. Completely useless.

  7. #7 Stephen
    May 20, 2010

    It would appear that Science Blogs are Grading their Own Test.

    I have posted Two comments to this Article… and both were deleted …

    Has Science lost it’s objectivety ?

  8. #8 PalMD
    May 20, 2010

    You’re welcome to comment all you wish, but advertisements will be deleted.

  9. #9 Composer99
    May 20, 2010

    @7:

    Hold off on some of those Capitalizations, man. People might start to assume you are a crank or a quack (inappropriate over-use of capitalization is often indicative of such things).

    Also, your claim re: “Science” losing its objectivity is patently ridiculous. This is a single weblog. Do you honestly believe that it speaks for all ‘Science’ or that any errors you perceive on PalMDs part represent meaningful indictments of ‘Science’?

  10. #10 nomuse
    May 21, 2010

    Am I the first geek to post just to point out that Goatee Spock is reading McCoy’s mind in the scene shown? The katra transfer takes place, of course, in “The Wrath of Khan.”

    Not that it matters, of course. Not even the Vulcans have a mental technique for infusing healing qualities into tap water.

  11. #11 PalMD
    May 21, 2010

    I was looking for a suitable caption and hoped no one would notice that. Thanks for the buzzkill, nomuse!

  12. #12 OleanderTea
    May 22, 2010

    A few years back, someone told me that “local” honey (no, not the stuff you get at the grocery store) helped allergies. That spring, my seasonal allergies were so bad (think prednisone bad) that I tried said local honey.

    It didn’t do a damned thing for my allergies (surprise!) but I did buy some nice honey from a local producer, and it made my tea taste yummy, so it wasn’t a total waste.

    This illustrates, of course, why people fall prey to the idea of homeopathy for allergies (and lots of other things). The options are limited, and when you get past Benadryl and Claritin, they have sucky side effects and/or take a lot of time and money.

    This spring, I’m on a regimen of Singlair, Claritin, and Rhinocort. It doesn’t taste as good as honey, but it’s way more effective.