Last partial update: July 2016 - Please read disclaimer before proceeding.
The use of complimentary medicines for illness prevention, symptom relief or treating undiagnosed illnesses
In all, about 2.3 billion dollars is spent in Australia on complimentary medicines including vitamins, herbal remedies and other nutritional supplements. (This is not too far behind the four billion spent on prescription drugs and of course all the cost of these supplements is borne by the purchaser.)
There are several important issues that need to be mentioned regarding the use of all treatments and medicines and particularly complimentary ones.
Evidence of benefit
The most important requirement of all health recommendations and treatments is that they provide an overall benefit to those who use them. This may sound obvious but it is only recently that traditional medicine has taken providing quality research to prove the benefits of treatments very seriously. This has been a really important change and will ensure better outcomes for patients for many years to come.
Research into traditional medicine is fortunate in that it is relatively well funded from both government and private sources. This is not the case with complimentary medicines and thus, in most cases, there is relatively little good evidence to support their use. This makes it very difficult for practitioners to recommend them with any certainty of benefit.
Placebo effect
It is well documented that taking a medication that has no beneficial effect (and that does not cause side effects), such as sugar tablets, will make people feel better in about 40 per cent of cases. Thus, feeling better after taking a medication does not mean it was the medication itself that produced the effect.
Reason for use
All treatments and medicines have complications and side effects and natural does not mean safe. Thus, it is important to have a good reason for using them. Many people take supplements and herbal remedies because they feel poorly and think that this is probably due to some deficiency. People who feel unwell need to find out the cause; not take something and in the hope that it might help.
Buy Australian-made herbal and natural products
While all natural and herbal remedies are not subject to the same level of government scrutiny as prescription medicines, people are generally still safer purchasing Australian-made products. (Although as the Pan Pharmaceutical incident in 2003 shows, even being Australian-made does not guarantee quality.) Some less reputable products, usually from overseas, contain additives not mentioned on the label. Some of these substances, such caffeine and ephedrine, are included because they provide more energy and thus make people feel better; at least temporarily. Steroids are also a common additive and although they provide short term benefit for many conditions, in the long term they can cause numerous serious harmful effects. Athletes need to be especially careful as taking many of these substances may result in positive drug tests. (See the Australian Institute of Sport web site for more detailed information. www.ais.org.au/nutrition).
Conflict of interest
Practitioners who financially benefit from the treatments they give and the medications they prescribe have a financial conflict of interest. (Doctors are not allowed to dispense medications for just this reason.) Sometimes these conflicts of interest are not obvious so be careful. For example, two practitioners may be financially connected by having the same employer (as happens in medical centres) or a dispenser of a herbal remedy may also be its importer. This does not mean that the treatment being offered is not the most appropriate. It just means that the patient’s best interest is not the only consideration; so be careful.
Vitamin and mineral supplements - When are they useful
All vitamins and minerals have been the subject of extensive study. The daily recommended intakes for vitamins and minerals that are advised by health authorities are based on all the well researched information available. There is no reason for them not to be! They are therefore the most reliable guide to vitamin and mineral intake. Those wishing to find out more about individual vitamins and minerals can do so by accessing the National Health and Medical Research Council’s recent (September 2005) and very comprehensive publication on this topic; Nutrient reference Values for Australia and New Zealand including recommended dietary intakes. (It is available free on their web site at: www.nhmrc.gov.au/publications/synopses/n35syn.htm
These recommended levels can be maintained in most people by adhering to their usual varied diet. Despite this, many Australians continue to purchase vitamins that are of no benefit. Some common reasons for this practice are as follows.
- Many Australians believe they eat very poorly and that they are likely to be deficient in vitamins etc. The truth is that our dietary problems are due to having too much food, especially fat and sugar. As stated above, vitamin and mineral deficiencies are rare in Australians.
- Some people believe that present day foods are poorer in quality and have less nutritional value. There is no evidence that this is the case.
- People often feel their stress and tiredness are due to a nutritional deficiency of some kind. This is rarely the case, although people who are chronically tired should have their iron levels checked, especially women with heavy menstrual periods.
- Many people seem to believe that vitamins have magical properties that will prevent a multitude of symptoms / diseases. Thus, they often take the attitude that ‘if some is good, more is better’ and feel that any increase in their vitamin intake is beneficial, or at least can’t hurt. This is not true and there are some vitamins that are toxic to the body if taken in excess. This is especially the case with fat soluble vitamins (vitamins A, D, E and K) which can be stored in the body in large quantities. Special care needs to be taken to avoid toxic doses of vitamin A (retinol), which in excess has been associated with an increase in hip fractures. (Also, high doses of beta-carotene (a precursor of vitamin A) causes an increases in lung cancer in smokers.)
- The placebo effect (see above) means that people often feel better when taking supplements even thought the supplement had no effect at all.
There are better things to spend hard earned money on!!
There are, however, some situations in Australia where micronutrients (vitamins and minerals) are deficient. This can occur either because the nutrient can be 'borderline deficient' in the diets of Australians or because a particular type of diet is deficient in a particular nutrient(s). In these cases supplements may be needed but it is best to discuss which supplements are needed with a GP or dietitian.
1. Deficiencies in specific vitamins / minerals.
These are discussed below or in other parts of this book.
- Folate: Folate supplements for women of child bearing age. These should be taken by any woman who has any likelihood of becoming pregnant as supplements have been shown to significantly reduce the risk of neural tube defects, a group of serious abnormalities that occur early in the life of the developing foetus. To be helpful, the woman needs to be on them when she becomes pregnant. (See section on 'Dietary, drug and medication issues in pregnancy')
- Calcium: Calcium supplements in those with a low calcium intake, particularly in post-menopausal women. (See section on osteoporosis.)
- Iron: Iron intake in women (and men) with diagnosed (by blood tests) iron deficiency and no other underlying cause, such as blood loss from a cancer. (See section on 'Iron deficiency')
- Iodine (See section on 'Iodine deficiency')
- Zinc (See table detailing 'Zinc rich foods')
- Magnesium (See section on 'Magnesium deficiency')
2. Specific population groups who are likely to have deficient intake of minerals and vitamins generally and require a multi-vitamin / mineral supplement.
- Frail aged people (See section on 'Malnutrition in the elderly')
- Some vegetarians (See section on 'Vegetarian diets')
- People with multiple food allergies or intolerances (See section on 'Food allergies')
- People who chronically abuse alcohol who are likely to be deficient in vitamins (especially vitamin B1).
- People with diseases affecting their bowel that reduce their ability to absorb vitamins and minerals from their diet. Such diseases are relatively uncommon and their treatment is beyond the scope of this resource.
- People with inadequate diet due to poverty or bizarre eating habits.
The vitamin message
Don’t assume a vitamin deficiency is the cause of a health problem as it may result in both missing / delaying making the real diagnosis and wasting money on unnecessary supplements. People who are worried about their diet or have a problem should talk to their GP about their concerns. He or she can advise about proper nutrition and help find the cause of any underlying condition, should one be present. People who still feel they need to take supplements should do so for as little time as possible and take a supplement that has a wide range of vitamins etc in concentrations that do not exceed the recommended daily allowance for each compound. Also, ensure that purchased vitamins are produced in Australia by reputable companies.
Antioxidants
The oxidation of body tissues and compounds is a damaging process that is continually being fought by the body. It is principally caused by unstable compounds called free radicals. Free radicals are unstable because they lack an electron in their structure. In order to become stable, they steal electrons from other compounds they come in contact with. The loss of this electron is a process termed oxidation and the resultant changes in the structure of the oxidised compound can disrupt its ability to function properly in the body.
Free radicals are produced by normal chemical reactions in the body, a process that can be increased in conditions such as diabetes and perhaps stress. Many different types of free radicals can also be ingested, a principle culprit being tobacco smoke. Others include alcohol, animal fats, smoked and char-grilled foods, oils heated during deep-frying and pollutants. Oxidation by these free radicals can affect blood lipids, the immune system, DNA (genes), enzymes, hormones, skin proteins etc. All this can lead to an increase in many diseases, including cardiovascular disease, cancers, and inflammatory diseases, such as arthritis.
As well as being fought by the body, oxidation reactions caused by free radicals can be prevented or reversed by antioxidants consumed in the diet. These are substances that have an extra electron that they can give away to free radicals (neutralising them) or oxised coumpounds (converting them back to 'normal'). There are two main groups of antioxidants; nutrients which play essential roles in processes in the body, such as vitamins C, E & beta-carotene, and various other compounds found in foods, including carotenoids, polyphenols, flavenoids, catechins & theaflavins (in tea). Hundreds of different antioxidants have been identified in vegetables, fruit, wholegrains, olive oil, nuts, tea, soybeans, dark grape juice and red wine, and many more are still being identified. Knowledge about which antioxidants are most beneficial is very limited at present and it is therefore advisable to have as wide a range of antioxidant-containing foods as possible.
The use of antioxidant and vitamin supplements for heart disease and cancer prevention
It is thought that antioxidants consumed via a normal diet do help prevent coronary artery disease (heart disease) and this has led to many people taking supplements of ‘antioxidant’ vitamins in the belief that they will also help reduce heart disease. There is now good evidence that, unlike antioxidants in food, these antioxidant supplements provide little or no benefit with respect to heart disease. Similarly, the protection against cancer that is provided so well by nutrients in vegetables and fruit cannot be replaced by supplements. In fact, taking large doses of only a few antioxidants can very occasionally be harmful.
The reason that taking antioxidant supplements is unlikely to be of benefit is that there are hundreds of different antioxidants and we are likely to need a wide range of them for good protection. Also, as we don’t know which are most beneficial or in what dose, it is not possible to know which antioxidants should be included in supplements. Antioxidant supplements generally do not supply the hundreds of antioxidants found in normal food and, in any case, it will not be possible to create helpful antioxidant supplements until a great deal more is known about this topic. In the meantime, taking antioxidant supplements for cancer or heart disease prevention is most likely going to be a waste of money.
Prebiotics and probiotics
Prebiotics are substances that can help ‘feed’ normal healthy bacteria in the bowel and thereby increase their numbers. Probiotics are supplements of actual bacteria normally found in the bowel that can be consumed. These products have been promoted to consumers on the basis that, by increasing the numbers of healthy / normal bacteria in the bowel, they can reduce the duration of diarrhoea associated with a bout of gastroenteritis or reduce the incidence / severity of diarrhea that can occur when taking oral antibiotics prescribed for an infection (i.e. antibiotic-induced diarrhoea). (This occurs because antibiotics kill normal bacteria in the bowel and their place is taken up by unhealthy bacteria that cause diarrhoea.)
Several studies have shown that probiotics can reduce the frequency of antibiotic-induced bouts of diarrhoea with about one in seven cases being prevented. However, the evidence to support their use is far from conclusive, with many of the trials done to assess the affects of these products having been either inconclusive or too small to take seriously. The issue of the extra cost involved also needs to be taken into consideration. Having said this, there is no evidence to say that they do harm and future trials may prove their efficacy.
Herbal and natural remedies
Many of the world’s most useful drugs and lethal poisons are derived from plants and animals; that is, ‘nature’. Natural does not mean healthy and it is important that any medication has been conclusively established as beneficial and free from unacceptable side effects before it is offered as treatment. This website does not mention herbal medicines or natural therapies for the following reasons.
- The evidence for the effectiveness of herbal remedies is poor, with few properly controlled studies supporting any benefit from these medications. This is partly due to the fact that the companies promoting these products do not have exclusive rights to their use and thus they are not prepared to fund this often expensive research. Nevertheless, without such evidence, it is difficult to confidently recommend these medications.
- There is less stringent regulation regarding the provision of these products. This means that the ingredients in similar herbal remedies may vary and that some products may be contaminated with potentially harmful ingredients. In the USA, a study found that nearly 33 per cent of randomly selected Asian herbal remedies were contaminated with arsenic, lead or undeclared pharmaceutical drugs such as steroids or caffeie(Bellamy, M. (2001)). Also, despite being natural products, a significant number of people taking these preparations suffer side effects. The same USA study showed 12 per cent of people using herbal remedies suffered side effects. It goes without saying that prescription medications have many side effects too.
- Another problem with natural remedies is that the person recommending and sometimes preparing the medication is often the person being paid for the medication, so a conflict of interest exists. (Conflicts of interest also sometimes exist in traditional medicine.)
All the above does not mean that herbal remedies have no beneficial effects. It is just that in most cases we do not know.
Finally, it is important to mention that natural medications can interact with other drugs. Therefore, people should mention all the substances that they are taking when consulting their health professional.
Selling nutritional supplements
People should be in no doubt that the priority of those selling manufactured health foods and nutrient supplements, such as vitamins, is to do just that. Sell. Their message will almost always be that one of their products will be of benefit and an unbiased view is unlikely to be presented.
The producers of nutritional supplements (and herbal remedies) are not regulated by government organizations such as the Australian and New Zealand Food Authority or the Therapeutic Drugs Administration. Thus, they are not required to give proof to these bodies that their claimed medicinal benefits are legitimate. Those selling these products are not required to have any formal medical education and this makes it difficult for them to assess any medical problem that a person thinks he or she might require a medication for. It also makes it difficult for them to assess the usefulness of the products they are offering for sale.
With the above in mind, people should be skeptical of any information or advice provided at stores selling such products. They have a conflict of interest. While written opinions by so called experts, often presented in the form of official looking articles or pamphlets, may be produced to support product claims, please remember that opinions are cheap and they mean nothing unless they are backed up by good research; something that is very difficult to determine in a shop.
Another often used sales technique is to provide free in-shop advice by an expert about improving health. Such advice is still only an opinion and, while it may have been given free, the products people are advised to purchase are not. This does not mean that the advice provided will necessarily be wrong or inappropriate. It will just always be compromised.
Further information
Nutrition Australia
www.nutritionaustralia.org
A non-government, non-profit, community-based organisation that has offices in all states and territories. It aims to promote the health and well-being of all Australians.
Food Standards Australian & New Zealand (FSANZ)
www.foodstandards.gov.au
Provide current recommendations regarding food standards in Australia. Lots of good information.) Ph 02 - 6271 2222
OzFoodnet
http://www.ozfoodnet.gov.au
A health network designed to enhance the surveillance of food-borne diseases in Australia.
Further information on food allergies
FARE - Food allergy Research and Education
www.foodallergyalliance.org
Australasian Society of Clinical Immunology and Allergy
www.allergy.org.au