Popular Natural Remedies, Part IV

This will be the fourth in a series of articles that I have written about natural products. It is estimated that approximately one-third of the United States citizens use complimentary and alternative medicine of some sort. After decades of seeing discussion of these topics dwindle in medical school classes in this country, we are now starting to see an upswing in the teaching of these areas. To prepare future physicians, 75 U.S. and Canadian medical schools now include complimentary and alternative medicine in their curriculum through electives, grand rounds, and visits to alternative clinics. In pharmacy schools, the class of pharmacognosy, which is the study of drugs derived from plants, is being revived after being almost completely taken out of the curriculum of most pharmacy schools. In this article I am going to take three popular natural products to which there is some documented evidence of efficacy and talk about those products. There will be two natural products discussed at the end of this article that are written about extensively in the lay literature, but for which there is no confirmed documentation of any beneficial use.

The first natural product that I wish to discuss is glucosamine. There are a number of people who will read this article who either personally suffer or know people who have aching knees caused by osteoarthritis. Osteoarthritis is a chronic condition that gradually destroys the cartilage in the knees. Osteoarthritis also affects other joints in the body as well. This cartilage in the knee separates the bones of the upper and lower leg. With osteoarthritis, after a number of years, the cartilage in the knee is totally destroyed, and the patient is left with bone moving on bone. This is a very painful condition, as well as very expensive medically to treat. Sufferers of osteoarthritis are the patients that you see who, in their 50s and 60s, become candidates for knee replacements. Glucosamine is dosed as 500 milligrams, three times a day. Some studies would show that the product can be used up to a 1000 milligram dose up to three times for a day, short-term in acute cases. There have been at least 15 studies that show glucosamine can be safe and effective in the treatment of various forms of osteoarthritis. Some researchers claim that this product is at least as effective and, perhaps, more effective than the traditional OTC and prescription only nonsteroidal anti-inflammatory agents. Glucosamine may slow and, perhaps, even stop the destruction of cartilage in the knee and perhaps cause limited regrowth of cartilage. However, it will not cause cartilage to grow in joints where it has been totally destroyed. There are mixed reviews about using glucosamine with chondroitin. The combination products, glucosamine and chondroitin, are somewhat more expensive than the glycosamine only products. The only caution coming out of the scientific literature, based on one study, is for those patients with bronchopulmonary medical conditions, which may worsen upon taking glucosamine.

The second natural product that I wish to write about is chromium. Chromium has received a lot of attention in the lay press in three areas: diabetes control, lowering cholesterol, and as an aid in weight reduction. During the past couple of decades, chromium has been produced in different chemical salt forms available on the market. However, it appears that it is only in the piccolate form (chromium piccolate) that it is medicinally useful. With regard to the treatment of diabetes, there has only been one proven mechanism of action by which chromium works. Studies show that supplemental chromium increases the number of insulin receptors in the body. Physicians and scientists are still working on whether or not there are other mechanisms by which chromium helps in glycemic control. Second, chromium has been shown to lower cholesterol in patients with diabetes, but its benefit may take months to appear. Chromium can lower total cholesterol and triglycerides and increase HDL levels in nondiabetic patients. Chromium piccolate is not indicated in the reduction of weight. Studies have shown that its claims to be a fat burner are not warranted. The recommended dose of chromium piccolate is 4 mcg/kg/day. However, most commercial preparations patient information indicate that a patient should take one 200 mcg tablet per day. Although chromium is considered one of the least toxic nutrients, there are some concerns with it. There has been some speculation that chromium piccolate can affect dopamine, serotonin, and norepinephrine metabolism in the brain. Therefore, it is suggested that chromium piccolate be used with caution in individuals prone to behavioral disorders.

The third product that I wish to discuss is Co-enzyme Q-10. Co-enzyme Q has been written about in the lay literature extensively since the early 80s when it was the darling of clinicians treating chronic fatigue syndrome. Although its use in the treatment of chronic fatigue has been discredited, there are a number of other areas to which it is proported to help, such as in the treatment of cardiovascular disease, stimulation of the immune system, treatment of periodontal disease, life extension, and in the treatment of some forms of muscular dystrophy. With regard to treating cardiovascular disease, Co-enzyme 10 supplements may be useful in treating congestive heart failure (CHF). Epidemiologic studies have found that CHF patients have significantly lower levels of endogenous Co-enzyme Q than do normal patients. It has been shown that 50-150 mg a day in divided doses improves the symptoms of congestive heart failure, improves stroke volume and increases ejection fraction, and also reduces left atrial size. Studies as to whether Co-enzyme Q-10 will stimulate the immune system are inconclusive at this time. There are two case reports that claim Co-enzyme Q supplements can improve survival rates of patients with AIDS-related complex. However, the studies have not been large enough to form any firm conclusions at this time. The use of Co-enzyme Q in periodontal disease has not been proven. Claims that Co-enzyme Q can extend one's life cannot be supported. Co-enzyme Q does not improve exercise tolerance as some people would claim. The normal daily dose of Co-enzyme Q is 100 mg daily in two or three divided doses. Higher doses are sometimes used for myocardial preservation in patients undergoing bypass surgery. It is recommended that patients check with their cardiologist before such doses would be used. There are no known serious adverse effects with Co-enzyme Q. Occasionally, patients complain of gastric discomfort, loss of appetite, nausea, and diarrhea; however, these symptoms are rare. Occasionally, asymmetric elevations in liver enzymes LDH and SGOT can occur. There is no reputable information about the use of Co-enzyme Q in pregnancy or lactation. At this time, there are no known documented drug interactions with Co-enzyme Q. Theoretical drug interactions that have not yet been proven include: acetohexamide, glyburide, phenformin, pravastatin, and simvastatin.

The next two natural products that I wish to discuss are those that receive a lot of lay press, but to which there has not been shown any documented medical benefit to humans. The first product that I wish to discuss is shark cartilage. The use of shark cartilage in the last 20 years has been widely claimed in the lay literature to be beneficial in the treatment of cancer, psoriasis, and rheumatoid arthritis. The original rationale for the use of shark cartilage to treat cancer was the observation by investigators that sharks do not get cancer. These well-meaning individuals sought the scientific basis for this phenomenon. They reasoned since shark cartilage is avascular and contains a cartilage inhibitor that prevents capillary blood vessel growth which is essential in tumor growth, it would be a potent cancer treating tool. While there have been some preliminary United States clinical trials to assess the use of shark cartilage in treating cancer for improved quality of life, decreasing pain, and increasing appetite, these studies are years away from completion. Since there is currently no substantial validated evidence that shark cartilage is useful in treating cancer, it should not be promoted as an alternative treatment in lieu of current "accepted" medical therapy. Studies that would support shark cartilage in treating psoriasis or rheumatoid arthritis are also nonexistent.

A second natural product which has been written up a lot in the literature recently, but to which there are no valid clinical studies, is methylsulfonyl-methane (MSM). MSM is a natural chemical in green plants. MSM has been said to alleviate GI upsets, musculoskeletal pain, allergies, boost the immune system and, most importantly, treat arthritis. MSM is being promoted by several "nutritional" companies, largely relying upon the testimonials of individuals who are well recognized by the public, such as James Coburn. However, much like shark cartilage, while valid clinical studies have been started, they are years away from completion. Given the number of other medicines out there to treat these medical conditions, it is my opinion it would be somewhat foolhardy for an individual to treat their condition with MSM when other treatments with proven track records are available.