ALTERNATIVE  REALITY

“Primum non nocere.” Above all do no harm. We all had to promise that before receiving our medical degrees.  One might think that is setting the bar pretty low, but really, it isn’t as easy as it seems! There’s a plethora of super-potent pharmaceuticals that are designed to help but also capable of effecting very serious, sometimes fatal damage. Even the most diligent physician can have a hard time culling reliable truths from the hyperbolic claims of drug manufacturers. Subsequently, many conventionally-trained internists, mindful of their Hippocratic Oath, have included non-prescription (a.k.a. “alternative”) therapies into their medical practices.

Alternative medicine basically encompasses all treatment strategies outside the standard western medical algorithms. It is a very loosely regulated industry, so it can be difficult for patients to know what is safe and what is not. (The F.D.A., for all its problems, at least does a relatively effective job keeping obviously toxic drugs off the shelves.) It is crucial for consumers to abandon the assumption that anything “natural” is good, or at least harmless; a quick review of Mother Nature’s arsenal will dispel that illusion! There are nontraditional regimens that are respected in many very traditional primary care practices; conversely, some “alternative” remedies are felt by most to be overtly dangerous.

Elevated cholesterol is a major risk factor for heart attack and stroke, and is regularly monitored and treated by primary care physicians. But when diet and exercise have been ineffective and prescription medication is advised, many people balk. This is understandable; it is hard to embark on even a mildly burdensome therapy with regular doctor and pharmacy visits in order to simply reduce the risk that something bad might happen in the future.

Yet scientific data overwhelmingly proves the benefit of treatment, so for those adamantly averse to prescription medication, the supplement Red Yeast Rice is a possible alternative. It contains monacolin, which was the base substance used to develop the very effective “statin” class of pharmaceuticals, and can significantly reduce the harmful LDL (“bad”) cholesterol. Communication with and supervision by a health care provider is still warranted, in order to determine whether this product is achieving its goal without harming the liver.

Mild depression and anxiety are common disorders treated in the primary care setting. Because of cost, stigma, or side effects, some patients are loath to take advantage of the highly effective antidepressants called SSRIs. In that case, the herb St, John’s Wart could be considered.  It has been shown to be quite efficacious in mild-to-moderate cases and is inexpensive and easily available. Physician evaluation prior to embarking on a course is advisable, as there are some important medical causes of mood disorders that should be ruled out.

Many a woman’s quality of life has been eroded by peri-menopausal symptoms, and the previously available quick fix of hormone replacement therapy is now rarely advised as it has been shown to increase risk of heart attack and stroke. Two natural supplements, black cohosh and evening primrose oil, are felt to be reasonable, low risk strategies to diminish the troublesome manifestations of hormonal changes.

Another condition commonly diagnosed and managed in the primary care setting is mild hypothyroidism, and while rarely dangerous it can disproportionately undermine life quality. Doctors can prescribe a very safe, purified thyroid replacement — but for patients that hope to avoid prescriptions, sea kelp can be helpful. A rich source of iodine, sea kelp helps maximize one’s own natural thyroid function.

I encourage people to discuss alternative medicine with their doctors, and ALWAYS let anyone who treats them know what supplements they are taking, so that adverse drug interactions can be avoided!

Remember–any substance you put into your body for the purposes of preventing or treating a disease is considered a drug.  Choose carefully, and keep your medical specialist “in the loop.”

Patrice Passidomo, M.D.
Board-certified, Internal Medicine

This article is sponsored by a generous donation from M&S of Pawling. http://www.mandsofpawling.com/