I have been practicing Integrative medicine for the last 13 yrs in the USA. The spectrum of the practice of Medicine has shifted dramatically in the last few decades due to multiple factors, including the cost, effectiveness, morbidity and mortality and others, too many to list. The use of CAM (Complementary and Alternative medicine) in USA has nearly tripled in the last 4 decades due to these factors. Most complementary health approaches fall into one of two subgroups—natural products or mind and body practices. I have noticed patterns of beliefs and confusion in my patients and the general population, so this article might help to clarify few of these common alternative health myths.

Complementary, Alternative, or Integrative Health: What’s In a Name?

Integrative medicine, combines alternative medicine with evidence-based medicine. Practitioners claim that it treats the “whole person,” focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship. The Academic Consortium for Integrative Medicine and Health has developed the following definition: “Integrative medicine and health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare and disciplines to achieve optimal health and healing.”

Advocates say that integrative medicine is not the same as complementary and alternative medicine (CAM) nor is it simply the combination of conventional medicine with complementary and alternative medicine.

They say instead that it “emphasizes wellness and healing of the entire person as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship”.

Myth: The assumed “safety” of natural herbs and medicines.
Truth: Just because it is “Natural” does not automatically mean it is “safe”

There are many herbs (all are natural) which have several side effects and interactions with different other herbs, supplements or prescription drugs you might be taking. It is always better to consult with your health care provider before you start on any new herb/supplement regiment to make sure it is safe and appropriate for you.

If you have a special condition, like pregnancy, breast feeding, slow functioning of liver, kidney, heart or other vital organs, it is crucial that you discuss starting the herbals with your provider first. There have been incidences of liver, kidney or heart failure when people have taken herbs without discussing the potential side effects with their providers.

The herbal products themselves can be contaminated or using cheap, inferior products or substitutions. In a recently published study, DNA barcoding was used to conduct a blind test of the authenticity for 44 herbal products representing 12 companies and 30 different species of herbs. Most (59%) of the products tested contained DNA barcodes from plant species not listed on the labels. One-third of these also contained contaminants and or fillers not listed on the label. Product substitution occurred in nearly 70% of the products tested and only 2/12 companies had products without any substitution, contamination or fillers. Some of the contaminants posed serious health risks to consumers.

The FDA keeps a tight watch on the products in the market. Here is a good link to keep abreast of the safety warnings/ list of recalled products from the market.

Myth: It’s cheaper than a doctor and medications
Truth: It is not “cheap” as one might think. Not in the short term.

Many alternative health providers do not accept insurance, thus costing us more out of pocket in the short term. The Herbs and supplements are likely not reimbursed by your insurance company. Your HSA/FSA might help save you some tax dollar amount. However, engaging in healthier practices and nutrition may help reduce our need for more drastic and chronic medical care in the long run. With its focus on long term preventative care, It might may save us money in the long run and achieve better and optimal health.

According to statistics released in July 2009 from a nationwide government survey, 83 million U.S. adults spent $33.9 billion out-of-pocket on visits to complementary and alternative medicine (CAM) practitioners and purchases of CAM products, classes, and materials.

Myth: Taking megadoses
Truth: More is definitely not better all the time! Note: This advice is particularly important for pregnant or breastfeeding mothers!

Fat-soluble vitamins like Vitamin A, D and E can be dangerous in high or megadoses, since they are stored in the fat and Liver, leading to different toxicities over time.

Most water soluble vitamins, like the B complex vitamins are usually safe to take in a little higher amount than RDA, (recommended dietary allowance), since most of them are flushed out in the urine. Exceeding 2,000 milligrams of vitamin C per day can cause diarrhea and kidney stones.

It’s nearly impossible for your regular diet to provide an overdose of vitamins D, E, K, C, and all the B vitamins.

Vitamin A is an exception. Liver and fish liver oils are concentrated sources of preformed vitamin A (retinol).  Cases of vitamin A toxicity also have been reported among children given daily servings of chicken liver or any animal liver, like seal or whale liver in the north and south poles.
Similarly if you are taking a higher/prescription dose of Vit. D due to deficiency, your provider might monitor the levels periodically to make sure it is in the safe range.

Only a qualified provider might recommend high doses for a specific condition such as large doses of niacin (vitamin B3) for helping reduce cholesterol, or prescription dose Vit. D for deficient patients with MS etc.

Exceptions: This is usually discussed case by case, but Older adults may benefit from taking more calcium, vitamins B-12 and vitamin D, since the body does not absorb these as well as it ages. Iron supplementation can be beneficial for young women, who need 18 milligrams of iron a day. Vegans may need extra calcium and B-12 and could benefit from taking supplements of iron and zinc.

Myth: I will be safe since I am just taking food, supplements and natural herbs!
Truth: This holds true for regular prescription medications also, since people fail to consider these facts:

Everything you put in your mouth has the potential to interact with food, herbs and prescriptions taken orally by altering the way the body metabolizes each of them. some herbs and foods can lessen or increase the impact of a drug by working as a catalyst or an enzyme booster or inhibitor, or interfere with the body’s ability to absorb micronutrients.

Good examples of food which interact with drugs are : Alcohol, acting on brain and liver metabolism; Grapefruit juice which interacts with Blood pressure medications, Hormones, OCP, statins and cholesterol lowering medications;
Orange Juice interacts with antacids with aluminum, and several antibiotics ; High fibre food can interfere with absorption of few drugs, like Digoxin and tylenol; Large amounts of broccoli, spinach, and other green leafy vegetables high in vitamin K, which promotes the formation of blood clots, can counteract the effects of heparin, warfarin, and other drugs given to prevent clotting; caffeinated drugs with asthma drugs and some antibiotics like Cipro and so on.

Myth: I do not need to talk with my Health care provider before starting any herbal formulas.
Truth: Mixing multiple herbs and drugs, can be an accident waiting to happen!

Herbal interactions with prescriptions can interfere with how the drug is metabolized by the body, increase side effects or toxicity of prescription medications, or block the intended beneficial effect of a drug. Always check with your doctor to check for herb Drug interaction before you start taking those. Your pharmacist is your big ally also when it comes to discuss herbal-drug interactions. Interactions between herbs and conventional drugs: overview of the clinical data.

“While many of the interactions reported are of limited clinical significance and many herbal products (e.g. black cohosh, saw palmetto, echinacea, hawthorn and valerian) seem to expose patients to minor risk under conventional pharmacotherapy, a few herbs, notably St. John’s wort, may provoke adverse events sufficiently serious to endanger the patients’ health. Healthcare professionals should remain vigilant for potential interactions between herbal medicines and prescribed drugs, especially when drugs with a narrow therapeutic index are used.

High-risk patients, such as the elderly, patients taking three or more medications for chronic conditions, patients suffering from diabetes, hypertension, depression, high cholesterol or congestive heart failure, should be especially on the lookout for such side reactions.

Coumadin/Warfarin, a blood thinner given to patients to prevent blood clots, is a nightmare for herbalists, doctors and pharmacists to manage the INR, since it is so easily affected by food, the Vit. K from green veggies and the liver metabolism makes it susceptible to have hundred of food/herb/drug interactions. Some of the food supplements which might make the blood more thinner, would be High dose fish oil, aspirin, feverfew, Gingko biloba etc.

Ginger, garlic, turmeric should be OK to take as food with Coumadin, but if you are taking it in a capsule or supplement form, you might need to watch the INR closely when you start these supplements (check here and here).

Myth: Natural medicines and Food supplements must be regulated similar to prescription drugs.
Truth: Close, but not exactly!

FDA states that dietary supplements are regulated under a “different set of regulations from those covering ‘conventional food’ and drug products” but this does not mean they are unregulated. In fact, with over 150 million Americans using dietary supplements annually with little problem, it is clear that supplements are held to strict requirements, ensuring their safety and efficacy.

Prescription and over-the-counter drugs are regulated by the United States Food and Drug Administration (FDA), which requires evidence of effectiveness, safety and quality control in manufacturing. Dietary/Food supplements (such as vitamins, minerals and many herbal products) are governed by the Dietary Supplement Health and Education Act (DSHEA) of 1994.

Consumers may look for marks of certification by groups like the United States Pharmacopeia (USP) on product labels, certifying independent testing and verification to contain the ingredients on the label, meeting requirements for purity and good manufacturing practices (GMP). Other third party testers like NSF, Consumer Labs, and Consumer Reports are also available.

If you’re wondering how to read a label and ensuring the safety of the product I really like looking at this chart to make sure I am reading the labels of supplements correctly.

Myth: All supplements in the market must be the same as long as the active ingredient is there!
Truth: Buying Cheap Quality, bulk /discount , poor formulated herbs , with toxic fillers and additives, which have not been tested independently, will never be up to par with well formulated, minimal fillers, hypoallergenic, Thoroughly checked ,and tested by third party, though slightly expensive formulations from reputable companies.

There are several good companies and brands available in the market. Discuss with your Integrative health provider to see what will work the best for you.
If I see too many chemically enhanced supplements, with a big inactive ingredient list, including fillers, colorants, “natural flavors”, xanthan or carrageenan gums, HFCS, or soy lecithin (Unless it says Organic for the last 2 ingredients) I cross those products off my list to choose from.

My General advice:

Be an Informed consumer:
https://nccih.nih.gov/health/decisions
How to go about selecting a CAM practitioner:
https://nccih.nih.gov/health/tips/selecting

For Part II: Click Here.

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Prachi Garodia, MD

Board Certified Internist, Integrative Medicine Specialist at Asante Physician Partners

Dr. Garodia believes in gently guiding patients to treat their physical, spiritual, emotional, and social components to optimize healing. She is board-certified in internal medicine and integrative medicine.

Latest posts by Prachi Garodia, MD (see all)

• What is your Gut Feeling? - April 25, 2016
• Common Alternative Health Myths: Part II - March 1, 2016
• Common Alternative Health Myths: Part I - March 1, 2016