“I don’t take chemicals,
I prefer natural herbal remedies!”
How often have we heard such statements? They are usually pronounced with an air of smug superiority and condescending pity towards those poor consumers who swallow paracetamol, ibuprofen, or other chemicals when having a headache or other health problem.
But the air of superiority seems misplaced because these ‘herbivores’ actually consume many more chemicals than the ‘chemivores’. What those who swear by ‘non-chemical’ medicines ignore is the fact that herbal remedies are packed with many different chemicals.
Below I have listed the main active chemical compound of some very well-known herbal remedies:
- Calendula (Calendula officinalis L.): flavonoids, triterpene alcohols, triterpene saponins, carotenoids, polysaccharides, essential oil
- Chamomile (Matricaria recutita L.): essential oil, sesquiterpenes, dicycloethern
- Echinacea (Echinacea purpurea): polysaccharides, caffeic acid derivatives, alkamides, polyacetylenes, essential oil.
- Eucalyptus (Eucalyptus globulus Labill.): cineole, euglobales, macrocarpales
- Garlic (Allium sativum L.): alliin [(+)- S-allyl-L-cystein sulfoxide], allicin (allyl 2- thiosulphate propane)
- Hops (Humulus lupulus L.): phloroglucinol derivates, essential oil
- Lavender (Lavandula angustifolia Mill.): linalyl acetate and linalool, tannins
- Liquorice (Glycyrrhiza glabra L.): triterpenoid, flavonoids, isoflavones, polysaccharides
- Peppermint (Mentha x piperita L.): menthol, menthone, menthyl acetate, tannins, flavonoids
- Valerian (Valeriana officinalis L.): essential oil, sesquiterpene acids, iridoids, lignans, caffeic acid derivatives, alkaloids
Whenever I explain this to a ‘herbivore’ (here defined as a person who prefers herbal to conventional medicine), she is initially taken aback but, as soon as she has recovered from the shock, she regains their superior attitude and says: “Ah yes, but these are natural chemicals; they cannot do any harm, you know.”
“No, I don’t know!” I then reply, “There are two errors in what you just said: firstly, many chemicals that plants produce are highly poisonous – in fact, some of the most potent toxins we know come from plants – and secondly there is no difference between a chemical XY produced by a plant and the same chemical produced in a factory.”
At this stage, we usually change the subject or part our ways.
34 Responses to I don’t take chemicals, I prefer natural remedies!
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What most people seem to forget is that the fate of nearly everything in the natural world is an early death. Also the reason plants produce chemicals with pharmacological effects in the first place is that they have evolved to be poisonous as a deterrent to being eaten.
Like this one, most medicines are from a plant and manipulated to be safe. These natural folks take the whole thing without a thought to safety. There are so many plants that can kill a human adult eating naturally.
Not sure about most. This site says 40%.
“A full 40 percent of the drugs behind the pharmacist’s counter in the Western world are derived from plants that people have used for centuries, including the top 20 best selling prescription drugs in the United States today.”
https://www.fs.fed.us/wildflowers/ethnobotany/medicinal/index.shtml#:~:text=A%20full%2040%20percent%20of,in%20the%20United%20States%20today.
Its far less than 40% these days. This site has the data for the last few years in convenient poster form: https://njardarson.lab.arizona.edu/content/top-pharmaceuticals-poster
From a quick glance through the top 200 from 2020, its hard to see *anything* that’s derived from a plant. You have to get down to no. 109 (Abraxane) which is the the famous example of paclitaxel: drug invented by a plant, far too rare to be harvested “naturally” but instead grown in cell culture, and so insoluble in water that it can’t be effectively dosed without being carried by a human protein (together the protein-drug combo is what makes it Abraxane).
Then the only other one I can see from a quick glance is good old aspirin (no. 190): based on something invented by a plant (salicylic acid) but modified by humans to make it useful.
There may be a handful of other examples I’ve missed, but its certainly not 40%
I have just had a look at the list. There are a lot of new cancer drugs there, many of them targeted therapies and monoclonal antibodies that were specifically developed to lock onto various molecular targets, based on an understanding of the molecular biology of cancer. I would imagine that they are near the top of the list as they are very expensive. Many of the rest are also relatively new and therefore still protected by patent, which means that the pharmaceutical companies can charge a high price for them for now, and of course they are the ones that are promoted against older and cheaper alternatives that are mostly just as good.
The list therefore seems to be ordering the drugs by profitability rather than usefulness or number of prescriptions (though as various family members and I owe our lives to a few of them I am not going to say too much about usefulness).
Heres a list of the top 50 drugs in the US in 2020 by number of prescriptions:
https://www.singlecare.com/blog/most-prescribed-drugs-2020/
Plant-derived ones that I can see are 15. Folic acid and 28. pseudoephedrine. If we add 28. dextromethorphan and 23. aspirin, as “not found in nature, but inspired by plants” then we are still under 10% of the list.
Top 10 list in Australia by doses/day has only metformin (again not found in nature, but certainly counts as inspired by a plant): https://www.nps.org.au/australian-prescriber/articles/top-10-drugs-2019-20
I think the ethnobotany site linked above must be pretty outdated.
Jim- do you not think that many of those potentially dangerous plants that could be consumed have been eliminated by much trial and error in the evolution of human dietary needs.? Knowledge of poisonous effects would have been discovered and avoided after that- this knowledge eventually being transmitted to other humans etc.?
James Kennedy is a fantastic chemistry teacher. He has assembled many interesting fact sheets about the ingredients of natural foods.
Banana e.g.:
https://jameskennedymonash.wordpress.com/2013/12/12/ingredients-of-an-all-natural-banana/
To paraphrase Dr David Colquhoun (I think): Why on earth would anybody want to take an unknowable dose of an ill-defined mixture of compounds of unknown purity and undocumented side-effects when medicine can provide them with precise doses of known compounds with assayed purity and documented side effects?
In 2010 the American Association of Poison Control Centers recorded 3 deaths from foraging plants and mushrooms.
Of course there were probably more cases not reported and this doesnt take into account other possibilities of death…supplement overdose, delayed care, tainted products, improper use, etc.
DC-quite so and I suppose you could quote a few examples where equally harmful outcomes have resulted from consumption of some medication or other? I only ask!
You didn’t add hemlock, seems it is a commonly used homepathic remedy: https://homeopathyplus.com/know-your-remedies-conium-maculatum-con/. Too bad they didn’t get the dose correct with Socrates.
Chris- they did get the dose of hemlock correct with Socrates. They wished to kill him!
Nah, I don’t need doctors and their poisons. I’m treating my arrhythmia myself, 100% naturally, with digitalis from my backyard – and I’m feeling absolutely grea
Quick! Has anyone got a bottle of Nelsons Rescura!?
Do the herbal remedies listed and others that are consumed or recommended contain highly poisonous potent toxins? Long term practice and experience should avoid such calamity- most of the time! There may be no difference between say Vitamin C (ascorbic acid) from the laboratory and that found in a tomato but common knowledge would indicate which is the preferred source due to the variety of other nutrients in the food source, not found in the pure laboratory construct. This is no defense of herbals v conventional medicines but simply indicating the reasons given by Prof Ernst are not so straightforward .
Um, no. The active substance content in plants can sometimes vary hugely, and if that active substance has a relatively small therapeutic window, not even the most experienced practitioner can ensure that a patient receives the correct dose. Also keep in mind that some patients show a stronger reaction to certain substances than other patients.
You are conflating food and medicine here.
It is very simple really: for food, natural(*) sources are generally better than anything synthesized or purified, for exactly the reason you mention: these sources often contain lots of important nutrients neatly packaged together, so that you only need a few different foodstuffs every day to get all that you need.
For medicine, it’s a completely different story. Effective medicines by definition influence the body’s chemistry, and you want that to happen as precisely as possible: only the active substance, in the optimal dose (i.e. the best balance between desired effects and side effects). This is almost impossible to achieve with unprocessed plant material; not only can the dose vary, but you may also get other substances that may or may not do something.
*: Disregarding for a moment that our current-day ‘natural’ food sources don’t actually exist in nature – 99% of what we eat is the product of centuries of human ingenuity, mostly cross-breeding to increase nutritional content and decrease harmful(!) constituents.
In view of the huge variety of concentrations of the active ingredient(s) in the herbal preps. and the variety of patients’ physiological differences I suppose there is lots of evidence demonstrating the harm caused by ingestion of these herbal preparations- just as there are the same physiological differences when regular medicines are consumed and for which there is abundant evidence of side effects of varying degrees. Is there such a thing, initially when prescribed, as an optimal dose of a regular medicine when the physiological/biochemical uniqueness of an individual is unknown in normal practice? Although the regular medicine is far easier, with it’s exact concentrations, to control than herbal preps. it is , as you say, the benefits against the risks. Are the herbal preps used without this underlying philosophy? I am interested in how cross breeding has resulted in decrease of harmful substances. I can understand genetic modifications in modern times . An example or two of previous ‘modifications’ to eliminate harmful constiuents would be interesting. Finally, are not pure nutritional supplements used as medicine in certain deficiency conditions?
No, there isn’t – mainly for the reason given further on.
For several types of medicine, certain individual characteristics are taken into account, e.g. weight, known allergies or sensitivities, or opioid tolerance, to name just a few. But you are right that regular medicines also have the problem of individual differences between patients, making it difficult to establish the optimal dosage (or even if a particular medicine is suitable at all for a particular patient).
Yes, and especially with regard to the benefits side. Many herbal preparations are used without existing evidence for efficacy, and when actually researched, a huge number of more or less popular herbal remedies don’t appear to do anything. Our host Edzard Ernst has done a lot of research in this field – no doubt he can provide links to some of his articles on this. IIRC, his research showed efficacy for maybe a few dozen herbal preparations of the many hundreds or even thousands out there. Some other interesting resources on effects and side effects of herbal medicines:
https://medlineplus.gov/druginfo/herb_All.html
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=1169
https://rationalwiki.org/wiki/List_of_medicinal_plants
However, when a herbal preparation has no effect, it is likely that it also has no or only few serious side effects – and that means that most of them are quite safe(*). And of course really dangerous plants such as digitalis (foxglove) are rarely used even by herbalists, simply because of the risks involved. Mind you, the active substance in digitalis (digoxin) is used as a medicine, but only in a purified form. The reason for this is the relatively small therapeutic window: the toxic dose is only twice the average therapeutic dose, so you really want to get the dose right.
The common potato is one example: like all plants from the nightshade family, it contains solanine, a potentially deadly toxin. The actual solanine content of potatoes depends on several factors (another example of the unpredictability of active substances already mentioned) – with the particular breed being one of them. In 1967, a new cross-bred variety of potato with several favourable properties was put on the market, but unfortunately, the solanine content was not taken into account there.
*: Aristolochia is one notorious exception, see e.g. https://pubmed.ncbi.nlm.nih.gov/12110620/ and https://www.bmj.com/content/344/bmj.e2644.full
Richard-thank you for a very considered response. I view herbal ‘medicine’ as a throw back to more primitive methods of treating human ailments real or imagined. They may have therapeutic value, perhaps none at all, possibly harmful and certainly placebo effects. In primitive, less developed societies with no modern medical facilities with access to the contents of Martindale or Goodman and Gilman’s panoply of drugs then tribal herbal ‘therapeutics’ ,with much experience to guide it , is better than nothing at all ( in my view). Modern medicine was not much or even better in it’s early beginnings. Just a thought- if a patient presented with well developed scurvy, a modern practitioner of medicine might be persuaded that pure vitamin c was the cure, yet full health will not be restored until vitamin C containing foods are consumed.
Mr Sugarman,
Yes and no. The specific treatment for scurvy is vitamin C, and it would be negligent not to administer it in a pure form. However, there are likely to be consequences of scurvey that also require treatment, so vitamin C on its own will only be one component of the patient’s management. They are quite likely to have other forms of malnutrition as well, and most importantly, the social factors which led to the scurvy in the first place need to be addressed.
In 30 years of medical practice I have only ever seen one case of scurvy. It was an elderly gentleman with psychiatric problems who lived alone on a strange and very restricted diet. I asked him if he ever ate any fruit: “Oh yes! I had some oranges a few months back. It was a very nice tin.”
The pharmacokinetics of all prescription drugs are published and readily available to physicians, including how and how well they are absorbed, how the drug is distributed among the various body compartments, the method of elimination and the rate (and the half-life if the elimination follows and exponential course).
Factors which affect the behaviour of many drugs include liver and kidney disease, but also other drugs (and foods, and herbal medicines) which either induce or block the enzymes that metabolise them, and anything that changes absorption in the gut. These are normally taken into account while prescribing, though if there is any doubt it is more common to use an alternative treatment than to adjust the dose.
Most drugs have a fairly wide therapeutic window (i.e. the toxic dose is a lot higher than the therapuetic dose). For those that do not, such as digoxin or warfarin, the dose is carefully monitored at the start of treatment and adjusted accordingly. Individual patients’ requirement for warfarin, for instance, can differ by a factor of ten.
For very toxic drugs with a narrow therapeutic window, such as cytotoxic chemotherapy, the dose is tailored to the patient on the basis of their size (usually surface area rather than weight), their glomerular filtration rate (i.e. how fast the kidneys are clearing the blood), and various other factors such as blood count and and liver enzyme activity. Sometimes specific enzyme assays are also required. Then the second dose is adjusted according to how the patient reacted to the first one.
Dr Julian-if you had practiced in a different environment, or experienced some historical causes of scurvy you may well have seen more than the occasional case of scurvy. Suppose pure vitamin C is not available, do you think that foods containing vitamin C and are digestible and absorbable wouldn’t have the same therapeutic benefit as your pure ascorbic acid? Scurvy was being cured or prevented long before the discovery and synthesis of ascorbic acid. Why would it be negligent not to administer pure ascorbic acid in the face of a scorbutic patient when certain foods, commonly available, would produce the same or even better outcomes? Your explanation of the protocols and practices of administering pharmaceuticals is clear and from your explanations nothing should ever go ‘wrong’. Yet all the treatments have at base a risk/ benefit consideration and as you well know there is no drug that can be considered to have no risk as is the case with those much maligned, often justified, herbals.
My practice has been in the UK in the 20th and 21st centuries. Of course it would have been different in other times and places.
It sounds as if you don’t have a lot of experience of dealing with very sick patients (and scurvy does make people very seriously ill – historically it was a common cause of death at sea).
If I prescribe a vitamin supplement, then I know exactly what the patient is getting, and it is recorded on his hospital drug chart whether he has taken it or not. The first priority is getting an effective dose of vitamin C into him.
As I stated before, this is only a part of his management, and his diet and the reasons why he got scurvy in the first place are key. For somebody to get scurvy in this day and age suggest that there are other very serious underlying problems, which would take more than just dietary advice to solve.
Dr Julian- correct- no experience of treating very sick people but I have experience of engaging with some very sick , dying people. But we are engaged in debating an approach to treating scurvy not other diseases which may require something quite different. In any event my experience of scurvy has been obtained from reading historical and nutritional texts and papers. If you have knowledge of any studies that demonstrate the superior efficacy of synthetic ascorbic acid compared with that found in fresh vitamin C containing food or juices then I would be very interested in the references. The reasons the patient developed scurvy will have a similar base origin i.e lack of food containing ascorbic acid- whether on long voyages at sea, under military siege in war time or polar expeditions etc and this is what needs reversing. There is nothing key about what of these examples resulted in the scurvy. A hospital chart for this condition will not be important in curing the patient. And your admitted lack of experience with this condition puts you at very little more advantage in assessing what is needed for these particular scorbutic patients. I have a lot of nutritional history supporting my view. The minimum vitamin C requirement to alleviate most of the symptoms of scurvy is about 10mg per day. Correct food selections , or juices can provide far in excess of this minimum requirement and can provide excess of the daily recommended requirements for the healthy person. Although your synthetic vitamin C will do no harm and certainly provide a great deal of relief from some very distressing symptoms it is not ‘better’ than selected foods and juices and is not essential, unless of course the foods are not available or there are other underlying conditions preventing utilization of the vitamin C. I have never read of any such conditions that could cause scurvy. If you have then references please.
Mr Sugarman,
I may not have a wide experience of treating scurvy – I doubt that many doctors in the UK have seen more than a handful of cases these days – but I do have experience treating very sick people. The first thing that you have to do is resuscitate them, which involves giving intravenous fluids and correcting metabolic abnormalities.
While it may be desirable in your mind to administer vitamin C in the form of orange juice or whatever, my priority is to improve their clinical condition and prevent them from deteriorating further. A sick patient may well be unable to swallow, or may not be reliably absorbing nutrients (or anything else) from their gut. An intravenous dose of a known quantity of whatever they are missing is reliable.
Save their life first, look at their diet and lifestyle once their condition is stable.
We are not talking about a healthy person here.
You clearly have not read widely enough. Any condition which affects the function of the gut can cause deficiencies of all kinds, including of vitamin C. Crohn’s disease, for instance, is a well-recognised cause of scurvy.
But as my director of studies at Cambridge used to say – you can’t learn to play a violin by reading about it.
In the case of my patient the underlying problem was schizophrenia.
Dr Julian-it may well be the case that there are co -morbidities that require intravenous administrations as you indicate and your case history and physical examination will indicate that particular requirement. But centuries of historical cases of scurvy, under varying conditions, have recorded many thousands of lives being saved by simple oral administration of the juices of ascorbic rich fruits and plant other juices. ‘Resuscitation’ in these sufferers was ‘miraculous’. Their improvement was immediate and their lives were saved. So would you agree that the ‘juices’ would be as effective as orally administered pure ascorbic acid but you ere on the side of caution in case of other complications that your case history or physical examination has or has not ‘discovered’? I appreciate your correction that I have not read widely enough- although I know that fact for everything I think I know- and your single example of Crohn’s disease as a cause of scurvy. Would that imply that the Crohn’s disease was left untreated or undiscovered until very far developed since scurvy takes many months ( about 8) to develop full blown symptoms with risk of death? I realize this is not a discussion of the healthy person but I was just indicating the normal requirements and therapeutic quantities of vitamin C in food or their juices is more than adequate ( with the exception(s) you indicate. Your director of studies at Cambridge is certainly oversimplifying how we may acquire different types of knowledge or experience and the implication in it’s use by yourself also shows some lack of understanding. Scientific knowledge may or may not be best acquired by a practicing scientist. History may best be understood by historians or maybe not. I may know as much about the beating heart as Richard Feynman or more about Stalin’s Soviet Union than the Medieval historian. I may know as much about scurvy, though certainly never complete, as a doctor in modern medicine who as myself rarely if ever crosses path with a patient with that disease. We may both acquire equal historical perspective if we wish to read those books about it. We cannot go back in time to actually experience the phenomena. You and I may both know much about the second world war by reading history etc. and we do not have to have been involved in that war. Of course actual experience of the events is something that cannot be properly displaced by reading. Even then experience in one arena gives no more knowledge than others with no war experience when considering different arenas never visited. We can read about it and learn a lot. So your experience in treating very sick people is irreplaceable but if say you wished to be up to date with the latest research on your scurvy patient how on earth is it possible without reading or attending lectures? Unless you are a biochemist in the field I can possibly know as much as you about the biochemical and molecular implications of vitamin C deficiency- by reading about it!
Mr Sugarman,
This exchange is getting more and more bizarre. The realities of treating the sick are rather different from how you suppose, and I don’t know why you appear to be trying to convince me otherwise.
The point I was making when I quoted my Director of Studies is that medicine is a skill, and like other skills it is gained through practice and experience, not simply knowledge. No amount of reading, for instance, will enable you to diagnose scurvy if you don’t know how to examine a patient, and simply replacing vitamin C, either in a purified form or in a food, is not going to help if you are unable to recognise other problems resulting from the deficiency, which could include dehydration, sepsis, acidosis or other metabolic upset requiring urgent attention.
Somehow I doubt this. At the very least I would expect any benefits from administering vitamin C to take several hours to become apparent.
Dr Julian-I was never , in the first instance, presenting any notion of how to medically attend and treat sick patients nor try to convince you of anything away from yours and well established medical practices ,except with the historical example of scurvy. I really do not disagree with most of what you write about the skills and knowledge necessary to be a practicing doctor with responsibility for sick patients. That was and is not why I brought up the subject of scurvy. But I think you have it dead wrong about not being able to recognize scurvy without all that medical education to which you refer. That education and science did not exist for hundreds of years yet scurvy was recognized, experienced and finally treated with huge success, saving countless lives, once the cause had been recognized/discovered as is well recorded. Just refer to the history of the lemon fruit alone to see the truth of what I say. By referring to the miraculous I did not mean to imply ‘instantaneous’ but as you say some time lag for the effects of the ascorbic acid containing fruit/juice to become metabolized. But after many months of immense suffering by the ‘afflicted’ it seemed and was miraculous to the recipient of the ‘cure’.
Mr Sugarman,
When something is common lay people will see it enough times to be able to recognise it. Smallpox, for instance, has a characteristic smell, and there was a time when this would have been familiar to anybody who had had a family member die of it, which was almost everyone. The same is true of most common diseases, though nowadays I think many parents would be hard-pressed to recognise, say, measles as opposed to other childhood diseases where there is a rash.
Seamen who had watched their fellows die of scurvy woiuld have had no difficulty diagnosing it. However, it is so rare nowadays that anybody presenting with the same clinical picture is much more likely to be suffering from something else, most probably acute leukaemia. If you saw an individual with gum disease, bruising and bleeding from the skin, weakness and anaemia, do you think you could reliably distinguish between scurvy and any number of infections, malignancies, autoimmine problems and connective tissue disorders that can can present in much the same way?
In reality it is very unusual to see a textbook case of anything, so you might be faced with a differential diagnosis of just one or two features, anaemia and gum disease, say. But it is unlikely to be as simple as that. These days the picture would be complicated by other co-morbiities. Historically seamen would have been otherwise fit, and their diet would contain adequate amounts of other nutrients most of the time, but anybody presenting with scurvy now would most likely have other nutritional deficiencies, as well as other features stemming from the reason they were unable to ingest or absorb vitamin C in the first place.
Dr Julian- I agree with your analysis. But one thing is not mentioned. If a patient presented with combination signs and symptoms of lethargy, bleeding gums, multiple very small bleeding lesions under the skin surface, bruising and painful joints, this alone, I suppose, could initially be misdiagnosed with other conditions, BUT if a case history is taken or known and there are indications that a substantial period has elapsed without the patient consuming fresh fruit or green vegetables then there would be , I hope, a paramount suspicion of well developed scurvy and the first therapeutic move would be to supply orally or intravenously ( if necessary) vitamin C followed by dietary alterations as soon as possible – as you described in a previous comment. All your possible other differential diagnostic tests would follow quickly. It would seem foolish, under the circumstances to initially refer the patient to a dermatologist, orthopedic or a dentist! I know you wouldn’t. If the diagnosis of scurvy is incorrect no harm would be done by the initial vitamin C administration and dietary alterations. Just another thought about reading and learning the violin with it’s implication to doctors education and training. It is self evident that clinical experience and much is essential before treating sick patients. BUT is it even imaginable that one could become a doctor without a great deal of reading. It is not a binary choice . The two are intimately linked hence the oversimplification of your education director’s example of which you have been impressed enough to make a point. My original ‘thought experiment’ of historical scurvy was introduced as an example where ordinary plant material was utilized to cure a very serious disease. Nevertheless I have found our extended discussion very interesting.
I always like to remind people that heroin and cocaine are perfectly natural plant extracts.
Heroin is a synthetic product produced by acetylation of naturally occurring morphine. It is not a perfectly natural plant extract- sorry!
Thomas- I used to think that heroin was discovered by acetylation of morphine and is not a direct natural product of any plant material!
So-called “herbal remedies” are a goldmine for every organic chemist. They can discuss ingredients for days and always discover something new.